Assessment of acute stroke care, stroke metrics and patient outcomes: analysis from the pre-implementation phase of the IMPETUS stroke study

Since they are measuring 'care' NOT RECOVERY! That just proves they are COMPLETELY INCOMPETENT!

Any 'assessment' that doesn't prove stroke is a complete shitshow wasn't done correctly! The mentors and senior researchers completely failed at providing correct instructions for this research!

Assessment of acute stroke care, stroke metrics and patient outcomes: analysis from the pre-implementation phase of the IMPETUS stroke study

Shweta Gupta¹Rohit Bhatia^1*Madakasira Vasantha Padma Srivastava¹Partha Haldar²Mamta Bhushan Singh¹Manish Salunkhe¹Imnameren Longkumer¹Deepshikha Prasad¹Risha Sarkar¹Vijay Sardana³Dilip Maheshwari³Bharat Bhushan³Alok Verma⁴Nikhil Dongre⁴Nikhil Sahu⁴Samhita Panda⁵Sucharita Anand⁵Biman Kanti Ray⁶Inder Puri⁷Paresh Zanzmera⁸Amit Gamit⁹Sanjeev Kumar Bhoi¹⁰Menka Jha¹⁰Priyanka Samal¹⁰Seepana Gopi¹¹Garuda Butchi Raju¹¹Amit Bhardwaj¹²Raminder Singh Sibia¹³Rupinderjeet Kaur¹³Ashutosh Tiwari¹⁴Niraj Kumar¹⁴Mritunjai Singh¹⁴Kiran Bala¹⁵Surekha Dabla¹⁵Mahindar Pal Singh Chawla¹⁶Jyoti Garg¹⁷Shishir Chandan¹⁸Rupali Malik¹⁹Thomas Iype²⁰Chithra Pushpa²⁰Ashok Kumar²¹Abhay Ranjan²¹Ravinder Garg²²Sulena Sulena²³Pramod Darole²⁴Gurpreet Chhina²⁵Shalin Shah²⁶Sudhir Shah²⁶Gajendra Ranga²⁷Smita Nath²⁷Alvee Saluja²⁸Lekhraj Hemraj Ghotekar²⁹Venugopalan Y. Vishnu¹Roopa Rajan¹Anu Gupta¹Deepti Vibha¹Rajesh Kumar Singh¹Awadh Kishor Pandit¹Ayush Agarwal¹Amit Rohila³⁰Pushpinder Khera³¹Sarbesh Tiwari³¹Suryanarayanan Bhaskar³²Mayank Garg³²Anupam Dey³³Satyabrata Guru³⁴Suprava Naik³⁵T. Sateesh Kumar¹¹Minakshi Dhar³⁶Naman Agrawal³⁷Mayank Patel²⁶Pranav Joshi²⁶

• ¹Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
• ²Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
• ³Department of Neurology, Kota Medical College, Kota, India
• ⁴Department of Neurology, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India
• ⁵Department of Neurology, All India Institute of Medical Sciences, Jodhpur, India
• ⁶Department of Neurology, Bangur Institute of Neurology, IPGMER, Kolkata, India
• ⁷Department of Neurology, Sardar Patel Medical College, Bikaner, India
• ⁸Department of Neurology, Government Medical College, Surat, India
• ⁹Department of Medicine, Government Medical College, Surat, India
• ¹⁰Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, India
• ¹¹Department of Neurology, Andhra Medical College, Visakhapatnam, India
• ¹²Department of Neurology, Dr. Rajendra Prasad Government Medical College, Tanda, India
• ¹³Department of Medicine, Government Medical College, Patiala, India
• ¹⁴Department of Neurology, All India Institute of Medical Sciences, Rishikesh, India
• ¹⁵Department of Neurology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
• ¹⁶Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
• ¹⁷Department of Neurology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
• ¹⁸Department of Neurology, VMMC & Safdarjung Hospital, New Delhi, India
• ¹⁹Department of Medicine, VMMC & Safdarjung Hospital, New Delhi, India
• ²⁰Department of Neurology, Government Medical College, Trivandrum, India
• ²¹Department of Neurology, Indira Gandhi Institute of Medical Sciences, Patna, India
• ²²Department of Medicine, Guru Gobind Singh Medical College, Faridkot, India
• ²³Department of Neurology, Guru Gobind Singh Medical College, Faridkot, India
• ²⁴Department of Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
• ²⁵Department of Medicine, Government Medical College, Amritsar, India
• ²⁶Department of Neurology, Sardar Vallabhbhai Patel Institute of Medical Sciences and Research, Ahmedabad, India
• ²⁷Department of Medicine, University College of Medical Sciences, New Delhi, India
• ²⁸Department of Neurology, Lady Hardinge Medical College, New Delhi, India
• ²⁹Department of Medicine, Lady Hardinge Medical College, New Delhi, India
• ³⁰Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India
• ³¹Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
• ³²Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, India
• ³³Department of Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
• ³⁴Department of Emergency Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
• ³⁵Department of Radiology, All India Institute of Medical Sciences, Bhubaneswar, India
• ³⁶Department of Medicine, All India Institute of Medical Sciences, Rishikesh, India
• ³⁷Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, India

Background: Stroke is a major cause of death and disability in India. Many stroke patients seek care(NOT RECOVERY!) at government medical colleges but studies have not comprehensively assessed the quality of acute stroke care(NOT RECOVERY!). This study aims to evaluate key indicators for optimal stroke care(NOT RECOVERY!) in the pre- implementation phase of implementation of an evaluation and treatment package for uniform stroke care(NOT RECOVERY!) (IMPETUS) study across 23 medical colleges in India.

Methods: IMPETUS stroke is a multicentric, prospective, multiphase, mixed-methods, quasi-experimental implementation study, comprising three phases. During its pre-implementation phase, baseline assessment of stroke care(NOT RECOVERY!) was performed using pre-structured case report form, among prospectively enrolled acute stroke patients.

Results: A total of 2,018 patients were enrolled during the pre-implementation phase. The mean (SD) age was 59.08 (14.4) years, with male preponderance (64.2%); 69.06% had an onset <24 h, majority had ischemic stroke (60.1%), followed by intracerebral hemorrhage (38.4%). Key risk factors were hypertension, diabetes, smoking, alcohol and previous stroke. Imaging performed included non-contrast computed tomography (NCCT) (69.6%), computed tomography angiography (CTA) (25.6%) and magnetic resonance angiography (MRA) (24.6%). Intravenous thrombolysis (IVT) was administered in 39.2% eligible patients, predominantly with tissue plasminogen activator (tPA) (72%). In-hospital delay was the most common reason for not receiving thrombolysis (44.8%). The median door-to-CT, CT-to-needle and door-to-needle time were 95, 36.5 and 67 min, respectively. Other important stroke care(NOT RECOVERY!) indices were also evaluated. In-hospital mortality was 19.4 and 33.1% patients achieved modified rankin scale (mRS) score 0–2 at 90-days.

Conclusion: This comprehensive data provides a representative baseline status of acute stroke care(NOT RECOVERY!) in select medical colleges across India, which will be useful in comparing advancements during the implementation phase and improve policy making.