BE-FAST (Balance, Eyes, Face, Arm, Speech, Time) Reducing the Proportion of Strokes Missed Using the FAST Mnemonic

A 14% failure rate using FAST for stroke identification and you didn't realize that maybe something better and objective is needed. Do you have any brains at all?
Maybe these 17 diagnosis possibilities to find out which one is the best? Or maybe the Qualcomm Xprize for the tricorder?
 
http://stroke.ahajournals.org/content/48/2/479?etoc=

Sushanth Aroor, Rajpreet Singh, Larry B. Goldstein

https://doi.org/10.1161/STROKEAHA.116.015169

Stroke. 2017;48:479-481

Originally published January 12, 2017

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Abstract

Background and Purpose—The FAST algorithm (Face, Arm, Speech, Time) helps identify persons having an acute stroke. We determined the proportion of patients with acute ischemic stroke not captured by FAST and evaluated a revised mnemonic.

Methods—Records of all patients admitted to the University of Kentucky Stroke Center between January and December 2014 with a discharge International Classification of Diseases, Ninth Revision, Clinical Modification code for acute ischemic stroke were reviewed. Those misclassified, having missing National Institutes of Health Stroke Scale data, or were comatose or intubated were excluded. Presenting symptoms, demographics, and examination findings based on the National Institutes of Health Stroke Scale data were abstracted.

Results—Of 858 consecutive records identified, 736 met inclusion criteria; 14.1% did not have any FAST symptoms at presentation. Of these, 42% had gait imbalance or leg weakness, 40% visual symptoms, and 70% either symptom. With their addition, the proportion of stroke patients not identified was reduced to 4.4% (P<0.0001). In a sensitivity analysis, if face weakness, arm weakness, or speech impairment on admission examination were considered in addition to a history of FAST symptoms, the proportion missed was reduced to 9.9% (P=0.0010). The proportion of stroke patients not identified was also reduced (2.6%) with the addition of a history of gait imbalance/leg weakness or visual symptoms (P<0.0001).

Conclusions—Of patients with ischemic stroke with deficits potentially amenable to acute intervention, 14% are not identified using FAST. The inclusion of gait/leg and visual symptoms leads to a reduction in missed strokes. If validated in a prospective study, a revision of public educational programs may be warranted.

Drip ‘n Ship Versus Mothership for Endovascular Treatment Modeling the Best Transportation Options for Optimal Outcomes

The solution to this is so goddamned easy. You get objective diagnosis of ischemic stroke in the ambulance without the need for a neurologist to read anything. Not scanners in the ambulance. Then deliver tPA in the ambulance, no need to get inside a hospital.
Maybe these 17 diagnosis possibilities to find out which one is the best? Or maybe the Qualcomm Xprize for the tricorder?
These people are only thinking of what is currently capable rather than what the best solution is and figure out a way to get there. They are stuck in the past just like your doctor who hasn't read a single research article since medical school. You don't want these people anywhere near you.


http://stroke.ahajournals.org/content/early/2017/01/18/STROKEAHA.116.015321 

Matthew S.W. Milne, Jessalyn K. Holodinsky, Michael D. Hill, Anders Nygren, Chao Qiu, Mayank Goyal, Noreen Kamal

https://doi.org/10.1161/STROKEAHA.116.015321

Stroke. 2017;STROKEAHA.116.015321

Originally published January 18, 2017

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• Info & Metrics

Abstract

Background and Purpose—There is uncertainty regarding the best way for patients outside of endovascular-capable or Comprehensive Stroke Centers (CSC) to access endovascular treatment for acute ischemic stroke. The role of the nonendovascular-capable Primary Stroke Centers (PSC) that can offer thrombolysis with alteplase but not endovascular treatment is unclear. A key question is whether average benefit is greater with early thrombolysis at the closest PSC before transportation to the CSC (Drip ‘n Ship) or with PSC bypass and direct transport to the CSC (Mothership). Ideal transportation options were mapped based on the location of their endovascular-capable CSCs and nonendovascular-capable PSCs.

Methods—Probability models for endovascular treatment were developed from the ESCAPE trial’s (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times) decay curves and for alteplase treatment were extracted from the Get With The Guidelines decay curve. The time on-scene, needle-to-door-out time at the PSC, door-to-needle time at the CSC, and door-to-reperfusion time were assumed constant at 25, 20, 30, and 115 minutes, respectively. Emergency medical services transportation times were calculated using Google’s Distance Matrix Application Programming Interface interfaced with MATLAB’s Mapping Toolbox to create map visualizations.

Results—Maps were generated for multiple onset-to-first medical response times and door-to-needle times at the PSCs of 30, 60, and 90. These figures demonstrate the transportation option that yields the better modeled outcome in specific regions. The probability of good outcome is shown.

Conclusions—Drip ‘n Ship demonstrates that a PSC that is in close proximity to a CSC remains significant only when the PSC is able to achieve a door-to-needle time of ≤30 minutes when the CSC is also efficient. (DTN<30 minutes is pathetic, it should be negative, figure out a way to get there.)

Hackney stroke patient denied an ambulance by 999 and 111 call handlers

So until they get objective, fast, non-neurologist stroke diagnosis kits in the ambulance this will continue to occur, they could then send an ambulance out, verify if an actual stroke is occurring and transport. So until then, if you have a stroke you better have all the classic symptoms, or knowing what the tick-list contains lie about your symptoms. The solution here is to go to the root cause and fix that; Lack of objective diagnosis, call handlers can't do that, it will require a trained person using the latest in stroke diagnosis protocols. Fixing the tick-list is a bandaid not a solution.
Maybe these 17 diagnosis possibilities to find out which one is the best? Or maybe the Qualcomm Xprize for the tricorder?
http://www.hackneygazette.co.uk/news/health/hackney_stroke_patient_denied_an_ambulance_by_999_and_111_call_handlers_1_4836957
A woman who had suffered a potentially fatal stroke was told to go and see her GP the following day instead of being sent an ambulance to rush her to hospital – because her symptoms did not match the tick-list used by their call handlers.

"I wouldn’t recommend anyone uses the 111 service. It might be ok if you have a cold but I wouldn’t even give it a chest infection"

NHS nurse Angela Braeger

Staff at the 999 and 111 numbers – which use similar software – considered 68-year-old Edna Braeger a non-emergency because she told them she was able to raise her hand above her head – the classic symptom of a stroke.
Despite not being able to move her hand at all, they told her not to worry and advised her to call back again if her symptoms got any worse, or to go to her GP later that day when they opened.
But feeling unwell and disoriented Mrs Braeger, a retired shop manager from Victoria Park, was convinced something was wrong - and starting to panic she phoned back her out-of-hours GP.
Luckily Dr Allison phoned 999 to call an ambulance herself, saying she couldn’t rule out a stroke. In a stark recording obtained after the event – which the Gazette has heard - the GP is asked: “Does this represent an immediate threat to her life?” and she replies: “I would say so.”
Her daughter Angela, an NHS nurse, has slammed the 111 service as incompetent.
“I wouldn’t recommend anyone uses it,” she said. “It might be ok if you have a cold, but I wouldn’t even give it a chest infection in case something was missed. They are trained in spreadsheet questions and it’s tick-box ‘do you fit the criteria or don’t you’. It doesn’t have to be you can’t raise your arm above your head if you have had a stroke - she could raise her arm but couldn’t move her hand. It’s more than that - and if they don’t recognise that they fail every patient that contacts them.”
The incident happened in October 2015 and Angela still finds it difficult to listen to the recording of her mum’s call. “When you listen you can tell my mum is disoriented. She is talking quite slowly. The worst case scenario is she could have been dead. Simple as really,” she said. The best outcome came from her treating herself with Aspirin. The stroke doctor said she did the right thing.”
Under NHS England’s proposed money-saving Sustainability and Transformation Plans (STP) for North East London (NEL), there are plans to roll out the 111 phone line.
A spokesman for the London Ambulance Service apologised for Mrs Braeger’s distress.
She said: “We prioritise all emergency calls so those in life-threatening conditions get the quickest response. From the information provided to us, the patient was conscious, breathing, alert and did not require an emergency ambulance. This is the recognised failsafe to telephone assessment and used throughout the UK.”
A spokesman for the NHS said they will investigate the matter: “We are sorry that the patient doesn’t seem to have received the care she needed,” he added.

StrokeApp NIHSS Calculator

Once again using subjective means to diagnose a stroke. Fuck-it-all, do it objectively, maybe these 17 diagnosis possibilities to find out which one is the best? Or maybe the Qualcomm Xprize for the tricorder? With this you better have the major classical symptoms to accurately diagnose a stroke and not be blown off by suggesting you are drunk or drugged.  I don't care that it has been used since 1983, is it 100% accurate? Appeal to authority and appeal to antiquity are not valid scientific reasons to keep using this.

 

StrokeApp NIHSS Calculator

Description

Ever wonder why the NIHSS looks so simple when neurologists or stroke nurse coordinators perform the assessment? What’s "double simultaneous stimulation"? What’s “stupor” mean? When did I test for “extinction” & how is “anosagnosia” pronounced? But mostly, how is an entire exam completed in under 10 minutes?

personalRN’s NIH StrokeApp Calculator has now made the NIHSS easy to use for any doctor or nurse from the ER to the floor, whether attending, resident, medical or nursing student! Our StrokeApp Calculator is the only automated NIHSS that streamlines clinical assessment without losing accuracy. This added efficiency becomes advantageous in a busy ER or ICU since acute stroke patients can be non-cooperative during NIHSS assessment, wasting precious clinical time and leaving patients, their loved ones & practitioners frustrated. Neurologists & stroke nurse coordinators have training and experience that allows their intuitive adjustment of the NIHSS to fit the patient's immediate clinical state and cognitive limitations. The StrokeApp Calculator's development reflects many consultation hours with stroke neurologists that are considered thought leaders in the specialty. Our calculator is designed to act as a mobile stroke neurologist on your iPad, providing insight to skip and automatically assign scores to questions with dependencies, and provide real-time adjustments based on the patient's:

- mental status
- comprehension
- visual impairment
- ability to speak, respond and interact, all of which may be affected by
- aphasia
- respiratory status requiring intubation for mechanical ventilation

All adjustments to the exam are in agreement with the rules and regulations set in place by the original NIHSS without alterations or omissions of the original 15 questions. Lastly, the StrokeApp Calculator is the only mobile application for the NIHSS supported by clinical studies at a Comprehensive Stroke Center to evaluate whether simple instructions & easy-to-understand multimedia educational content of the calculator will allow for higher accuracy obtained in less time.

We believe that healthcare should be user-friendly for everyone, whether patient, caregiver or provider. Since 1983, the NIHSS has proven to be an exceptional clinical assessment tool for the assessment of stroke by doctors & nurses. personalRN’s NIH StrokeApp Calculator preserves the standardization of the NIHSS, which has allowed for its reliability, reproducibility and validity over three decades. The NIHSS has now become accessible to any healthcare provider at any stage of their training, from the first responders like paramedics or firefighters, or rehabilitation specialists like PT, OT & speech therapists.

Stroke outcomes can be worse when they occur in hospital, Canadian study finds

The takeaway from this is that when you do have a stroke you need ALL the classic symptoms, dropped mouth, slurred speech, total paralysis and loss ofsensation on one side.  This will not get better until people are removed from the diagnosis. We need fast, objective and cheap stroke diagnosis, maybe these 17 diagnosis possibilities to find out which one is the best? Or maybe the Qualcomm Xprize for the tricorder?

Stroke outcomes can be worse when they occur in hospital, Canadian study finds

Date:

October 6, 2014

Source:

Heart and Stroke Foundation of Canada

Summary:

At the first sign of a stroke, time is of the essence. For every minute of delay in treatment, people typically lose almost two million brain cells. Yet a new study reveals that those delays -- in getting the right tests and the right drugs -- can be longer when people experience a stroke in a hospital. "Intuitively, you would imagine that having a stroke in the hospital is the best place possible, and that is just not the case," says one expert. 

 

Investigators from the University of Toronto Faculty of Medicine, the Institute for Clinical Evaluative Sciences (ICES) and the University Health Network looked at data from acute care facilities in Ontario over nine years. They examined stroke care delivery and outcomes for two groups: those who had a stroke in the community (about 32,000 people), and those who had a stroke while already hospitalized for another reason (just over 1,000 cases), such as, for example, a hip replacement. The results were surprising.
"Intuitively, you would imagine that having a stroke in the hospital is the best place possible, and that is just not the case," says Dr. Alexandra Saltman, a third year internal medicine resident at the University of Toronto, and one of the authors of the Code Stroke on the Ward study.
Compared to the patients brought into a hospital from the community, people with in-hospital strokes:

• waited significantly longer from the time stroke symptoms were recognized to neuroimaging (i.e., a CT scan);
• waited longer from the time a stroke was confirmed to getting clot-busting drugs; and
• were less likely to receive clot-busting drugs than those who were admitted following strokes outside of hospitals, even when they were eligible.

The study's authors made the comparisons using the Heart and Stroke Foundation's Canadian Stroke Best Practice Recommendations and the American Heart Association best practice guidelines for stroke care. After adjusting for age and other factors, the in-hospital stroke patients also had longer hospital stays and were more likely to be disabled.
"There is evidence that people do worse when they have a stroke in the hospital, and not just because they are already sicker," says Dr. Saltman.
She suggests two possibilities for what seems to be a lag in response, despite the fact that the patient is surrounded by health-care professionals.
First, the signs of a stroke are too often overlooked. When patients are admitted for other medical reasons (for example, heart surgery or pneumonia), hospital staff on that ward are understandably focused on that ailment or condition, and are not specifically looking for stroke symptoms.
"We're all human, and things get missed," says Dr. Saltman. "In a medically or surgically complicated patient, it may be harder to detect the stroke symptoms than in someone with no other acute issues."
This is an important reminder for hospitals to promote awareness of stroke. "Awareness of stroke signs and how to react is important for all health care professionals, in any specialty," says Patrice Lindsay, director of stroke best practices and performance for the Heart and Stroke Foundation. "The reality is that people can have a stroke in hospital regardless of why they are hospitalized."
When an in-hospital stroke is identified, Dr. Saltman attributes a slower than expected response to a second factor: a lack of a standardized approach. When patients are taken to the hospital with a suspected stroke, "code stroke" protocols are in place. A team is ready to assess the patient, obtain and read images, and implement the appropriate treatment.
"When somebody has a stroke on a ward, no such standardized approach exists," says Dr. Saltman.
Lindsay says that it is mainly a systems and organizational issue, not the healthcare professionals who care for patients; it highlights an opportunity for increased awareness, standardized protocols and better coordination between internal departments throughout all acute care hospitals.
"Hospitals already have sound protocols on handling strokes coming in from the community," she says. "We need the same awareness and services within the hospital for patients who are already admitted, to ensure their rapid access to stroke care."
Hot topic in stroke: awareness of the signs Recognizing the symptoms of a stroke and acting quickly can prevent disability and save lives. A survey for the Heart and Stroke Foundation found that two-thirds of Canadians arrive at hospital too late to meet the treatment window for clot-busting drugs (or other interventions that can minimize the effects of a stroke).
Whether people have a stroke in the community or in the hospital, the clock is ticking. To respond as fast as possible, it's vital for the public and health care professionals alike to know the stroke signs and to treat them as a medical emergency:

• Weakness: Sudden weakness, numbness or tingling in the face, arm or leg.
• Trouble speaking: Sudden temporary loss of speech or trouble understanding speech.
• Vision problems: Sudden loss of vision, particularly in one eye, or double vision.
• Headache: Sudden severe and unusual headache.
• Dizziness: Sudden loss of balance, especially with any of the above signs.

Quick action in recognizing and responding to the signs of stroke is essential, as the clot busting drug tPA can reduce the severity of a stroke and reverse some of the effects, but only if it is administered within a few crucial hours after symptoms begin for someone who has a stroke caused by a clot.
Research creates survivors
This research highlights the opportunity to create more survivors though increasing awareness and developing in-hospital protocols ─ and for more good news stories such as that of Chloé Rodier.
In 2011, the then 16-year-old, who was hospitalized for pneumothorax, woke up with a strong headache. "I asked my mom to check with the nurses if I could have some Aspirin. When I tried to try to take the pills with my left hand, I saw that it wasn't moving. I looked at my mom and told her that I couldn't feel my arm. The specialists got there quickly, and many tests had to be done to diagnose the stroke. The doctors told me that I was lucky, that things could have been worse: I could have lost my speech and memory."

 

Researchers to develop innovative hybrid technology for quicker diagnosis, treatment of strokes

Do they even know about these 17 diagnosis possibilities to find out which one is the best? Or maybe the Qualcomm Xprize for the tricorder?
http://www.news-medical.net/news/20161216/Researchers-to-develop-innovative-hybrid-technology-for-quicker-diagnosis-treatment-of-strokes.aspx

FAU has demonstrated its strength in research once again: the University is conducting a new research project together with Siemens Healthcare GmbH, Universitätsklinikum Erlangen and other European partners in which researchers will develop an innovative hybrid device that combines different medical imaging technologies and will help stroke patients in particular to receive quicker diagnosis and treatment.
The project is being funded by the European Institute of Innovation and Technology for Health (EIT Health), a publicly financed initiative that aims to ensure sustainable development of innovative health care solutions. The project 'Predictive Prevention and Personalized Interventional Stroke Therapy - P3 Stroke' is one of only two in Germany and eight in Europe to receive funding.
EIT Health connects successful regional clusters with international networks of excellent universities, institutes, university hospitals and commercial research centres through the European research and innovation framework programme Horizon 2020. Over 140 companies, research institutions and universities from across Europe collaborate on a diverse range of projects as part of EIT Health; FAU and Siemens Healthineers are among the key partners.
The initiative will receive around 80 million euros of annual funding over the next seven years. Thanks to these resources, EIT Health is able to develop innovative products, educational programmes and services that will help Europe to deal with the challenges of demographic change.
To receive sought-after funding from EIT Health, a group of partners must submit a high-quality project. Prof. Dr. Dr. Jürgen Schüttler, Dean of FAU's Faculty of Medicine, is delighted that this was achieved with the P3 Stroke project: 'The project strengthens the connection between the University, Universitätsklinikum Erlangen and partners in industry such as Siemens Healthineers, a collaboration that meets the highest standards in Europe.'
Time is brain - faster treatment for stroke patients
'With the P3 Stroke project we want to improve the diagnosis and interventional treatment of strokes on a fundamental level by combining the use of magnetic resonance imaging and angiography,' explains Dr. Heinrich Kolem, CEO of Advanced Therapies at Siemens Healthineers.

Conducting separate examinations using different devices takes time, particularly due to the need to transfer patients between locations. This is valuable time that stroke patients do not have. As an average of 2 million neurons are destroyed every minute, every minutes counts during efforts to prevent major damage after a stroke. In collaboration with Siemens Healthineers, the team of researchers led by Prof. Dr. Arnd Dörfler, head of the Department of Neuroradiology at Universitätsklinikum Erlangen, and Prof. Dr. Andreas Maier, head of the Pattern Recognition Lab at FAU, now want to combine two imaging techniques, magnetic resonance imaging and angiography. This innovative approach will be used for diagnosis and immediate treatment, reducing the time needed for patient transfers and saving valuable time when treating stroke patients.
'The pioneering system enables an exact picture of the development of the condition to be obtained without delay, allowing for effective treatment,' Professor Dörfler says. While the clinical evaluation of the new methods will be led by the Department of Neuroradiology at Universitätsklinikum Erlangen in close collaboration with the Department of Neurology, the Pattern Recognition Lab is responsible for developing the software: 'We have been conducting research in various areas of medical imaging for many years and can therefore contribute a considerable amount of expertise,' Professor Maier explains.
Although the researchers see stroke patients as the main group who will benefit from the new technology, this does not mean that it will be limited to this area. 'The system will also have applications in minimally invasive treatment for other neuro- and cardiovascular disorders and in oncology,' Professor Dörfler says optimistically.

Source:

University of Erlangen-Nuremberg

MedyMatch aims to offer second opinion in stroke diagnosis

It would be much more useful to get to an objective diagnosis of stroke, Get the damned neurologists out of the loop. This assumes that even for young patients there already is a tentative diagnosis for stroke. That is not currently  the case considering all the misdiagnosed young patients.
You fund researchers to test out these 17 possibilities to find out which one is the best. Or maybe the Qualcomm Xprize for the tricorder.
http://www.timesofisrael.com/medymatch-aims-to-offer-second-opinion-in-stroke-diagnosis/

The real life Dr. Shepherds – yes, this is a reference to the popular medical drama “Grey’s Anatomy” – who work in hospitals around the world may soon get a new assistant. No, not just another intern but an extra pair of virtual eyes to help them better diagnose stroke victims.

Tel Aviv-based MedyMatch Technology Ltd., which hopes to have its first commercially available product as soon as the first half of 2017, is developing an artificial intelligence (AI) platform for critical areas of patient care. The platform is meant to help study data more quickly and accurately than the human eye, and help physicians with their clinical decisions in a wide set of healthcare issues.

MedyMatch’s first area of focus will be for stroke patients.

“Speed is essential in treating stroke,” Gene Saragnese, MedyMatch chairman & CEO, said in an interview. “For every minute that ticks by, brain cells die.”

When dealing with stroke, the very first question doctors need to address is what kind of stroke they are seeing: is it a bleed in the brain or a blockage that prevents blood flowing to the brain? The two types of stroke are treated in a very different manner. A wrong diagnosis and treatment could mean the death of much-needed brain cells.

“Our goal is to make better decisions in that very first step in a stroke – so those patients can get moved into the appropriate treatment quickly,” Saragnese said.

The product is software that takes images from a standard CT machine and processes them in the cloud, using proprietary algorithms developed by MedyMatch. The software makes notes on the image, highlights areas for physicians so they can immediately see potential areas of bleeding – and sends the image back to the doctor’s workstation, together with the original.

The process is expected to enable doctors to get an expert opinion within three to five minutes, Saragnese said. With deep learning a series of examples are fed to the computer to set benchmarks for what is considered a baseline reading, said Saragnese, a former CEO of Philips Imaging Systems who joined MedyMatch as CEO in February. Then you upload a whole series of images to the computer – and the machine learns what a bleed looks like from those images. Basically, “you are training the computer with examples in a way that it can then start to read images by itself,” he said.

MedyMatch has secured billions of images from millions of cases via collaborations with hospitals in Israel and the US, including Hadassah Medical Center in Jerusalem and Massachusetts General Hospital in Boston. “Those places are where our experts are coming from. They help us train the software to read,” Saragnese said.

Stroke is the fourth-biggest killer in the US, and costs to treat stroke may increase from $71.6 billion in 2010 to about $183 billion by 2030, according to data published by the American Heart Association. Despite advances in medical imaging, the medical misdiagnosis error rate of around 30 percent rate has not changed for decades, said Dr. Gabriel Polliack, a director of strategy development at TEREM, a network of emergency medical centers in Israel.

“There is a need in the marketplace to provide radiologists and physicians a second set of eyes to help them overcome any limitation that is preventing them from providing a correct patient diagnosis,” said Polliack said. Polliack is a member of MedyMatch’s medical advisory board and has been actively advising the company since its founding over two years ago.

“The idea is great, and not only has significant clinical value, meaning improvement of patient outcomes, but it will have a direct impact on the cost of care,” Polliack said. “This means that MedyMatch is addressing the holy grail in the medical profession, that is, providing better patient outcomes while lowering the costs.”

MedyMatch is in the process of raising an additional $8 million in funding, after it completed an initial financing round of $2 million earlier this year, Saragnese said. Its product will need to get FDA and other approvals.

 

3 Ways to Improve Pre-Hospital Stroke Care

An analysis of this paper. I think they are still missing the forest for the trees. Existing stroke diagnosis is almost a complete failure, especially for young people. Fix that first, you fund researchers to test out these 17 possibilities to find out which one is the best. Or maybe the Qualcomm Xprize for the tricorder.

The original article here:

Journal of the American College of Cardiology

Source Reference: Mokin M, et al "Recent endovascular stroke trials and their impact on stroke systems of care" J Am Coll Cardiol 2016; DOI: 10.1016/j.jacc.2015.12.077.

The analysis here:
3 Ways to Improve Pre-Hospital Stroke Care
 

VIDEO: Endovascular therapy key approach to improve time to treatment in acute ischemic stroke

Actually you are wrong, you have no idea of the correct approach to this. The key approach to improve time to treatment is to solve the diagnosis problem. Make it objective and remove the scans and neurologist from the equation. Many possibilities if you are following research at all.
This is easy to solve; you fund researchers to test out these 17 possibilities to find out which one is the best. Or maybe the Qualcomm Xprize for the tricorder. No installing scanners in the ambulance, that is a waste of money. The goal should be to deliver tPA fast enough to prevent the neuronal cascade of death. But first you'll need research to determine how fast that needs to be.
 None of this lazy door-to-needle time, in the ambulance for tPA should be the goal.
http://www.healio.com/cardiology/stroke/news/online/%7B7940c895-c29f-4e8a-b183-ac57f5d3f954%7D/video-endovascular-therapy-key-approach-to-improve-time-to-treatment-in-acute-ischemic-stroke?utm_source=maestro&utm_medium=email&utm_campaign=cardiology%20news
Gregg Fonarow, MD, professor of cardiovascular medicine at UCLA, discusses the role of endovascular therapy in improving the treatment of patients with acute ischemic stroke, an area of focus at the American Heart Association Scientific Sessions 2015.

Highlighting onset-to-treatment time, Fonarow discusses the clinical outcomes observed with stent retrievers in context of the sole pharmacologic therapy, IV tissue plasminogen activator (tPA), shown to benefit this population.

“Time matters. Time is brain,” he said. “The time for the patient to get to the hospital and the time of arrival to beginning treatment … is critically important in limiting the size of stroke and improving functional recovery.”(Then solve the diagnosis problem)

Fonarow details “remarkable findings” from the AHA’s Target: Stroke Initiative as well as continued efforts to speed the process from arrival to diagnosis for patients receiving tPA and endovascular therapy.

Finally, he outlines the organized approach needed to achieve outcomes in practice with endovascular therapy including data collection, tracking and national goal-setting.  

“We’re beginning the work to capture the valuable data and assemble the teams that will be necessary working together to identify best practices,” Fonarow said. “The time to now speed our therapy for acute ischemic stroke is upon us.”

Specialized ambulances expedite stroke treatment

This is still way too slow and requires way too much specialized equipment and trained people.
No fast, easy, accurate and objective way to diagnose a stroke is the problem needing a solution, both ischemic and hemorrhagic. This is easy to solve; you fund researchers to test out these 17 possibilities to find out which one is the best. Or maybe the Qualcomm Xprize for the tricorder. No installing scanners in the ambulance, that is a waste of money. The goal should be to deliver tPA fast enough to prevent the neuronal cascade of death. But first you'll need research to determine how fast that needs to be.
 None of this lazy door-to-needle time.With no realization of the goal in minutes after stroke there can be no solution.
http://www.modernhealthcare.com/article/20160104/NEWS/160109988

Cleveland Clinic and the University of Texas Health Science Center at Houston ​have been leading​ clinical trials of mobile stroke unit vehicles, which enable hospitals to treat patients 40 minutes faster than traditional methods.  Still way too slow.

Armed with on-board imaging equipment, telemedicine equipment and lifesaving drugs, the ambulances provide faster treatment for stroke, which can cause brain damage with every passing moment. Experts say strokes often aren't treated quickly enough.

“It's about being responsible not only for the inpatient but what happens to that patient (before they arrive and) after they leave. When we thought about these topics we were thinking about that continuum,” said Diane Robertson, director of health technology assessment information services at ECRI, ECRI, a membership organization that evaluates medical technologies.

The vehicles—which were pioneered in Germany—made ECRI Institute's Top 10 Hospital C-Suite Watch list for 2016. Many of the items help providers reduce costs and curb readmissions such as warm perfusion systems for donor organs, miniature leadless pacemakers and blue-violet LED light fixtures that kill bacteria.

MSUs are modified ambulances that include a mobile blood lab, a heads-only CT scanner and telemedicine equipment that can send diagnostic images and help first responders communicate with neurologists at the hospital. UT and Cleveland Clinic each launched a single vehicle in 2014 and exclusively used them for stroke cases. Care teams are dispatched by a 911 operator when it's believed a patient is having a stroke.

Workers on the units normally include a critical-care nurse, a CT technologist, a paramedic and a driver. Normally, the crew will perform CT scans and blood testing at the scene and begin transporting the patient while a diagnosis is underway via telemedicine, said Robert Maliff, director of applied solutions at ECRI.

The MSU model allows a physician to more quickly decide whether life-saving tissue plasminogen activator therapy should be administered to break down blood clots in a patient's brain. Not all types of stroke call for t-PA therapy, but the unit can help physicians determine whether a patient should immediately receive the lifesaving drug.

Even the most sophisticated, highly efficient stroke programs have delays in getting patients to imaging equipment or receiving test results, Robertson said. MSUs start that process earlier and streamline treatment at the hospital.

“Stroke is a very common occurrence and we don't treat it very well,” Robertson said. “We don't get patients the necessary treatment they need soon enough.”  But you don't even know how quickly that even needs to be. Without that knowledge all these shots in the dark are worthless. Damn it all, rub two of your neurons together and actually think before you shoot.

With current modes of treatment, only 3% to 8% of U.S. stroke patients receive t-PA, because it must be administered within four-and-a-half hours of the onset of symptoms, according to the Cleveland Clinic. Patients often don't get treated within this timeframe because they don't immediately realize they've had a stroke, or because they've been misdiagnosed by first responders.

Preliminary data from both Cleveland Clinic and UT show patients on the units are treated within an average of 64 minutes, as compared to a 104-minute timeframe often found in the emergency room.

But the vehicles don't come cheap: ECRI estimates that the total fixed and continuing costs over five years for UT's rig will be $1.65 million. That includes a $375,000 mobile CT scanner, a $60,000 retrofit of the vehicle, $30,000 in telemedicine equipment and other ongoing expenses related to labor and telemedicine network coverage.

MSUs are among the innovations resulting from health systems' transition to value-based care and their ability to tackle care-delivery issues that have traditionally been outside of the hospital's responsibility. Stephanie Parker, a nurse and program manager of the UTHealth mobile stroke unit, said other providers won't embrace the units until ongoing studies provide enough data to show improved patient outcomes.

“You're not going to have wide adoption unless we can show that patients have better outcomes and that this is cost-effective,” Parker said. “If our study is positive, I could see it going across the country very quickly.”

UT is also examining whether it may be beneficial to include a physician on its unit, as is the norm for all ambulances in Germany. Funding is also a key hurdle to overcome in widespread implementation, she said, noting that the CMS needs to consider whether it will provide higher reimbursement for patients treated on the units, because hospitals will be much less likely to invest in the program if it's not cost-effective.

Dr. Shazam Hussain, head of Cleveland Clinic's stroke program, said the units could prove particularly useful in a rural setting where first responders must go vast distances to reach patients. He said some rural providers are considering having an MSU rendezvous with community ambulances that retrieve patients who live far from major hospitals. That saves time for the MSU.

Hussain compared the invention of MSUs to EKG machines, which first began to appear on ambulances to expedite heart attack treatment. There's often little hospital providers can do before a patient undergoes a CT scan(Bullshit, solve the objective diagnosis problem), which is what makes the pre-hospital scan so effective, he said.

“I think it's becoming clear at least from the stroke standpoint, given it is a time-sensitive treatment, that we have to be looking at ways to get to our patients faster,” Hussain said.

Improving Human Activity Recognition and its Application in Early Stroke Diagnosis

Stroke diagnosis is pretty much a failure right now. Would anything here be better?  
Test out these 17 diagnosis possibilities to find out which one is the best?  Or maybe the Qualcomm Xprize for the tricorder? 

http://www.worldscientific.com/doi/abs/10.1142/S0129065714500361

José R. Villar

Corresponding author.

Computer Science Department, University of Oviedo, ETSIMO, Oviedo, Asturias 33005, Spain

Silvia González

Instituto Tecnológico de Castilla y León c/López Bravo 70 Burgos, Burgos 09001, Spain

Javier Sedano

Instituto Tecnológico de Castilla y León c/López Bravo 70 Burgos, Burgos 09001, Spain

Camelia Chira

Computer Science Department, Tech. University of Cluj-Napoca, 28 Gh. Baritiu Street, 400027 Cluj-Napoca, Romania

Jose M. Trejo-Gabriel-Galan

Neurology Department of the Burgos' Hospital, Burgos, Spain

Accepted: 4 November 2014

Published: 16 February 2015

The development of efficient stroke-detection methods is of significant importance in today's society due to the effects and impact of stroke on health and economy worldwide. This study focuses on Human Activity Recognition (HAR), which is a key component in developing an early stroke-diagnosis tool. An overview of the proposed global approach able to discriminate normal resting from stroke-related paralysis is detailed. The main contributions include an extension of the Genetic Fuzzy Finite State Machine (GFFSM) method and a new hybrid feature selection (FS) algorithm involving Principal Component Analysis (PCA) and a voting scheme putting the cross-validation results together. Experimental results show that the proposed approach is a well-performing HAR tool that can be successfully embedded in devices.

Whitepaper: Telestroke Tips: How to Reduce Time to Treatment - NSA

Very simple, you don't do telestroke at all because you have diagnosed and started treatment while in the ambulance. The BHAG should be in the ambulance, getting rid of the scan and the neurologist. This is definitely doable.  Test out these 17 diagnosis possibilities to find out which one is the best?  Or maybe the Qualcomm Xprize for the tricorder?    But don't worry, NONE of these will be tested, you'll be screwed just as you normally are. If that isn't your goal you need to get out of the way and let some actual leaders take over.
Failure on a grand scale once again.
http://support.stroke.org/site/MessageViewer?em_id=30613.0&dlv_id=45049

View this message on our website.

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We are pleased to introduce a new educational offering in the REACH Health telemedicine series. Whitepaper: Telestroke Tips: How to Reduce Time to Treatment Telestroke Tips: How to Reduce Time to Treatment Download the white paper now. The introduction of telestroke technology has delivered vastly expanded access to expert stroke care. But these improvements did not result from the technology alone—they required thoughtful adaptations of existing stroke evaluation and treatment protocols. Growing acceptance and utilization of interventional therapies have likewise necessitated a fresh look. In light of these advancements, REACH Health has assembled practical advice for minimizing door-to-needle and door-to-puncture times into its latest white paper, Telestroke Tips: How to Reduce Time to Treatment. This white paper explains telestroke-specific best practices for reducing time to treatment for tissue plasminogen activator and endovascular therapy. These suggested tactics are clinically validated and have been used in successful telestroke programs throughout the country. Topics cover the entire stroke continuum of care and include: Emergency Department & neurology training Program performance metrics EMS & community education Telestroke triage Collaborative teleconsults And more Download the white paper now: Telestroke Tips: How to Reduce Time to Treatment This email does not imply National Stroke Association's endorsement of any product, treatment, service, or entity.

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Stroke Rounds: Telemedicine Shortens Door-to-Needle Time

Big f*cking whoopee.
The BHAG should be in the ambulance, getting rid of the scan and the neurologist. This is definitely doable. 
Test out these 17 diagnosis possibilities to find out which one is the best?  Or maybe the Qualcomm Xprize for the tricorder?    But don't worry, NONE of these will be tested, you'll be screwed just as you normally are.
http://www.medpagetoday.com/Cardiology/Strokes/55065?

Nearly half-hour saved in innovative program, (So? Was that fast enough to stop the neuronal cascade of death? That would be the a main definition of success.)

A mobile stroke treatment unit (MSTU) operated by Cleveland Clinic which uses telemedicine to connect emergency team members to a hospital-based vascular neurologist, reduced time to tPA treatment by more than 25 minutes in an analysis of the first 100 patients transported.
Ninety-nine of the 100 transports were successful with just one connection failure occurring due to crew error, and door to CT completion times were also shortened, researcher Ken Uchino, MD, and colleagues wrote in the journal JAMA Neurology, published online Dec. 7.

Cleveland Clinic is the first medical center in the country to incorporate telemedicine into MSTU transport in an effort to reduce stroke assessment and treatment times and eliminate the need for a neurologist on board the ambulance. The initiative is being conducted in partnership with the city of Cleveland, the Cleveland Emergency Medicine Service, and other area participating hospitals.
More than 400 patients have been transported by the telemedicine-assisted MSTUs since the program began operations in July 2014.
"With this approach the neurologist could potentially be in another city or even another state," Uchino told MedPage Today. "We have shown that mobile stroke evaluation and treatment is feasible."
Uchino explained that the MSTUs, which are staffed with a registered nurse, paramedic, emergency medical technician (EMT), and a CT technologist, are dispatched when 911 operators suspect possible stroke.
CT is performed on board the MSTU and a neuroradiologist remotely assesses the images obtained by CT. The ambulance is also equipped with its own lab to measure prothrombin time, blood glucose, electrolyte levels, hemoglobin levels, platelet, and leukocyte counts.

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During the initial phase of the program from July 18 to Nov. 1, 2014, the MSTU was deployed 317 times; dispatches were cancelled in 217 of these cases before hospital arrival.
The remaining 100 patients (31.5%) underwent urgent evaluation in the MSTU. A diagnosis of probable ischemic stroke was made in 33 patients, and 26 of these patient (78.8%) were transferred to one of three comprehensive stroke centers, while seven received treatment at a stroke-certified hospital.
The telemedicine assessment was successfully completed in 99 of the 100 attempts, with the failure occurring when the power supply to the telemedicine station on the MSTU was not switched on and video could not be initiated. This patient was transported to the nearest emergency department where stroke evaluation was performed.
Ninety-three telemedicine assessments were conducted without transmission disruptions and the median door to video log-in time was 11 minutes (interquartile range, 7-17 minutes). The median video log-in duration was 20 minutes (IQR 14-27 minutes).
Video disconnections occurred in six instances, with five occurring due to poor wireless reception and one due to the use of a tablet computer by the neurologist which was not compatible with the devices on the MSTU. No video disconnections lasted longer than 60 seconds and they were not determined to have adversely affected clinical care.

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Ninety-nine of the 100 patients had CT performed in the MSTU and 16 received IV tPA in the MSTU. One additional patient was a candidate for MSTU-delivered IV tPA, but could not be evaluated because of video failure. This patient received IV-tPA after hospital arrival.
When the 100 MSTU patients were compared with 56 patients matched for age and stroke severity who were evaluated at hospital emergency departments, median door to CT completion time, door to international normalized ratio result time, and time to IV tPA administration were found to be shorter in the MSTU group:

• Time from door to CT completion was 13 minutes in the MSTU group (IQR 9-21 minutes) and 18 minutes in the ED group (IQR 12-26 minutes)
• Time from door to IV thrombolysis was 32 minutes in the MSTU group (IQR 24-47 minutes) and 58 minutes in the ED group (IQR 53-68 minutes)
• Time to CT interpretation did not differ significantly between the two groups

Uchino noted that earlier attempts at using telemedicine to evaluate and treat stroke patients before hospital arrival have been hampered by technological issues that limited connectivity.
"Improvements in wireless network communication in just the last few years have made this less of an issue," he told MedPage Today.
In an editorial published with the study, Martin Ebinger, MD, and Heinrich Audebert, MD, of Charite-Universitatsmedizin, Berlin, Germany, wrote that stroke is an obvious candidate for telemedicine because symptoms "are audiovisually transmittable and computed tomographic images can be easily accessed remotely."

"Obviously, replacing a personal encounter with a telemedicine consultation has its limitations," they wrote. "However, in a time-critical scenario such as stroke, the advantages of fast decisions about thrombolysis or thrombectomy may outweigh the shortcomings. Most patients with stroke faced with the two options of no neurologist(the goal should be no neurologist because we have objectively determined which way to go) or an expert telemedicine consultation would clearly prefer the latter."

Common Misdiagnoses for Stroke

And all these problems could be eliminated if we followed up on research to have a fast, easy and objective diagnosis with no neurologist involvement.
Test out these 17 diagnosis possibilities to find out which one is the best?  Or maybe the Qualcomm Xprize for the tricorder?  
None of which are mentioned in this article.
It's pretty much what I expect from StrokeSmart and the NSA. Another failure. Sure, blaming the victim for not being able to convince the doctors they are wrong and know nothing about stroke diagnosis.
http://www.strokesmart.org/misdiagnosis-for-stroke
Because symptoms of stroke can be mistaken for many different things, stroke patients may need to speak up and advocate for themselves to make sure they get a proper diagnosis and the care that they need as soon as possible.
A delay in treatment can increase the severity of a stroke, so a swift and proper diagnosis is paramount.
Here is a look at common misdiagnoses for stroke.

Being Drunk or on Drugs

Someone who is drunk or on drugs may act in a way or exhibit symptoms that can be confused with stroke symptoms.
For example, they may stumble, or be unable to walk straight, and their speech may be slurred.
So a stroke patient may need to be prepared to repeatedly answer that they are sober.
Be clear and firm with a doctor or hospital staff that you are not under the influence of drugs or alcohol, and that your symptoms need to be addressed.

Stroke During Pregnancy 

Each year several thousand women in the United States have a stroke while pregnant, in delivery, or in the first few weeks following delivery.
And warning signs of stroke, such as facial drooping and arm weakness, could be mistaken for other symptoms during pregnancy.
For example, inflammation of the facial nerve could cause a pregnant woman’s facial muscles to droop.  And carpel tunnel syndrome, a very common symptom during pregnancy, can cause tingling and weakness in the inner portion of the arm.
Reach out to your doctor immediately if you believe you are experiencing any warning signs of stroke before or after a pregnancy. 

Blurred Vision

Problems with vision including double vision, blurriness, and losing sight in one eye can all be signs of a stroke.
Don’t dismiss these symptoms for tiredness or old age, or allow a medical professional to make the same conclusion.
A blocked blood vessel reducing the amount of oxygen reaching an eye can cause any of these vision problems. So if you experience a sudden vision problem, don’t rule out the possibility of stroke.

Other Misdiagnosed Signs of Stroke 

If you are not prone to migraines, a sudden and severe headache could be a sign of stroke, as could sudden numbness or weakness in an arm.
If you experience any of these symptoms, don’t hesitate to call 911 and reach out for help. Don’t underestimate these symptoms or allow a medical professional to do the same without checking for the possibility of a stroke.

Every Patient Will be Misdiagnosed Once, Study Warns

From a lot of the comments I see on Facebook there are lots of stroke survivors that are totally misdiagnosed. We need a fast, accurate, inexpensive and no need for a neurologist diagnosis for stroke.
Test out these 17 diagnosis possibilities to find out which one is the best?  Or maybe the Qualcomm Xprize for the tricorder?   
 Our stroke associations should have statistics on how many patients are misdiagnosed and have a strategy to solve that problem. But shit they will be doing nothing like usual. We are totally screwed because no one is working on solving all the problems in stroke.

http://www.wallstreethedge.com/every-patient-will-be-misdiagnosed-once-study-warns/26455/
Most people will be misdiagnosed at least once throughout their lifetime, the Institute of Medicine (IOM) has revealed on September 22.

According to the findings, published in the “Improving Diagnosis in Health Care” report, urgent improvements are needed in the health care system. Nowadays, everyone risks receiving a “meaningful” inaccurate or belated diagnosis, which might have disastrous consequences.
An error of this type is defined as “failure to (a) establish an accurate and timely explanation of the patient’s health problem(s), or (b) communicate that explanation to the patient”.
Misdiagnosis is usually caused by rush in identifying a cause for the patient’s symptoms, insufficient communication with doctors and nurses, and improper interpretation of lab tests or X-rays.
Overall, every year around 5% of the adult patients who receive ambulatory care are misdiagnosed, and 10% of all patient deaths are linked to such errors. Inaccurate medical verdicts are the most widespread cause of malpractice lawsuits, and other claims are half as likely to have resulted in death by negligence.
The importance of detecting with accuracy every health issue, based on its symptomatology, has been evident recently, when an Ebola patient was misdiagnosed.
Thomas Eric Duncan ,a Liberian man who had contracted the virus, was initially told he had sinusitis and abdominal pain when he arrived at the Texas Health Presbyterian Hospital emergency room.
He was prescribed antibiotics and was sent home, but his state worsened and eventually he was hospitalized again. In the intensive care unit, he was finally diagnosed with Ebola, but it was already too late and the patient eventually succumbed to the disease.
Other similar cases have been reported, such as cancer patients who are diagnosed when their tumors have already metastasized, because doctors didn’t conduct enough tests to identify the illness in its early stages.
Another patient filed a complaint at IOM claiming she was told by medical staff that she had acid reflux, when in fact she had suffered a heart attack, which resulted in serious damage.
Back in 1999, the Institute of Medicine brought to light that between 44,000 and 98,000 deaths occur in hospitals, due to preventable medical errors. As a result of this report, emphasis has been placed on improving primary care and patient safety, but little attention was given to the importance of setting the right diagnosis.
Nowadays, IOM is calling for health organizations to go through their records and identify such errors, so that they can be prevented in the future. Government officials are also urged to support more research in this field, especially by funding autopsy studies to identify the prevalence of misdiagnosis.
Moreover, health practitioners should collaborate with patients, by actively involving them in the medical examination process and taking their ailments more seriously. They could also use “decision support” tools which list a variety of potential diagnoses, based on a set of symptoms.
In addition, doctors should share their findings, upon pinpointing the correct illness or disorder, after others have failed. By turning such collaboration into a norm and increasing transparency and disclosure, health officials could learn from one another and improve their diagnosis skills.

'Time is brain' in stroke assessment and treatment - Postdoctoral scholar awarded fellowship for research transforming acute stroke triage

With the background in CT scanning there is no way he is going to solve the problem of delivering tPA in the ambulance. He defined the problem wrong from the start; The problem is how to get the fastest diagnosis to determine clot vs. bleed for tPA administration?, NOT How do I deliver a CT scan faster? This is what he should be looking at;  Test out these 17 diagnosis possibilities to find out which one is the best?  Or maybe the Qualcomm Xprize for the tricorder? 
http://www.ucalgary.ca/utoday/issue/2015-08-14/time-brain-stroke-assessment-and-treatment
When a patient arrives at the hospital(already you are behind the eight ball) showing signs of a stroke, every minute counts. At the Foothills Medical Centre, the internationally acclaimed stroke team immediately begins assessing the patient when they arrive so that treatment can begin as soon as possible.

“Time is brain — you lose 2 million brain cells per minute during a stroke due to a blood clot in the brain," says Christopher d’Esterre, postdoctoral scholar and recipient of the 2015 T. Chen Fong Fellowship in Medical Imaging Science. "You need to have information quickly, and it has to be accessible and it has to be right, or else things will go wrong in a flash.”

d’Esterre is researching computed tomography (commonly known as CT) perfusion scanning for quick assessment of acute stroke, and how it can inform treatment.

“With CT perfusion, you inject a small amount of an inert liquid into the blood and take a picture of the brain every few seconds as it travels to the affected area. This liquid gives the image contrast so that you can see blood vessels and blood velocity,” he explains. “Using a very fast computer and a little bit of complex math, we generate blood flow images of the brain. This tells us what tissue is dead, what tissue is critical, and what tissue is not affected. We can also get a sense of whether the patient is at risk of bleeding into the brain.”

The stroke team is also working on constructs that can tell them about the characteristics of the blood clot in the brain. According to d'Esterre, “the constructs tell us where the clot is is, how long it is, and whether it can be broken down using a clot-busting drug or whether it needs to be surgically removed. Surgical removal is more invasive but most effective, as shown in the recent ESCAPE trial."

Improving process behind stroke treatment triage

The primary goal of d’Esterre’s research is to improve the decision-making process for stroke treatment triage at Foothills and around the world. “We’re trying to develop easy to interpret scoring methods based on imaging that can help clinicians make a decision quickly and correctly, and have it standardized everywhere,” he says.

“Chris d’Esterre is a bright young scientist in the early stages of his career, and is already part of team that is transforming health outcomes for all Canadians,” says Ed McCauley, vice-president (research). “He exemplifies the opportunities that exist for University of Calgary postdocs to contribute to world-changing research. We are thrilled that he has been awarded this fellowship.”

Using an example of a stroke patient in Lethbridge, d’Esterre explains the role of CT perfusion in the critical first moments of triage. In the scenario, the patient is over an hour away, so understanding how and when brain tissue will be affected is paramount.

“We have to decide whether we transport the patient to the Foothills hospital where we have the ability to remove the clot surgically, or if we want to keep the patient in Lethbridge. Surgical intervention isn’t currently possible in Lethbridge, but the clot-busting drug may have an equal probability of dissolving the blood clot as does surgical intervention - we need to determine this probability and act accordingly,” says d’Esterre. “Imaging is very important in making this decision as it will tell us the probability of both the drug dissolving the blood clot, and how much brain will be alive by the time the patient gets to Foothills hospital.”

According to Dr. Bijoy Menon, d’Esterre’s supervisor and member of the Hotchkiss Brain Institute, this research has already had a positive impact on the triage process.

“As stroke physicians, we rely heavily on imaging to make decisions, and Chris has used his skills and expertise with CT perfusion to tell us who are the right patients to have the mechanical clot-removal treatment,” he says.

Bridging communication gap between scientists and clinicians

When d’Esterre began his fellowship as part of the Calgary Stroke Program at the Foothills in 2013, he had his first hands-on clinical experience. “To see my basic science and physics background applied directly to stroke clinical care was the coolest aspect for me,” he says. “During my PhD training, I didn’t get to see the emergency stroke procedures in real time, and now I’m working directly with the neurologists who are making the acute treatment decisions."

Menon credits d’Esterre’s fundamental science background with making him such an effective member of the stroke team.

“Chris has also been able to bridge what I call the communications gap between translational scientists and clinicians,” he says. “He brings expertise where he is able to talk to us and talk to the scientists through a common language, helping us build more collaboration.”

Learn more about advancements in acute stroke treatment at the University of Calgary.

Extremes of stroke symptoms attract misdiagnoses

Wrong, wrong, wrong, you don't need more training of ER doctors, you need to come up with a fast, easy and objective test that doesn't need a doctor at all.
When are we going to fund researchers to test out these 17 diagnosis possibilities to find out which one is the best?  Or maybe the Qualcomm Xprize for the tricorder?  

http://www.news-medical.net/news/20150724/Extremes-of-stroke-symptoms-attract-misdiagnoses.aspx
Patients with very mild or very severe stroke symptoms are at the greatest risk of being misdiagnosed in the emergency department, research suggests.
These “stroke chameleons” were mostly missed by emergency physicians, who failed to consider a stroke diagnosis in 91.5% of the 47 patients studied. However, neurologists also did not consider stroke in 57.6% of the 33 patients about whom they were consulted.
“Based on our data, some stroke chameleons may be preventable in part by educating physicians about unusual presentations of stroke”, say Benjamin Richoz (Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland) and co-researchers. They also suggest lowering the threshold for consulting a neurologist.
Another problem was coexisting neurological and psychiatric conditions, which “often masked correct stroke diagnosis”, leading to misattribution of symptoms in 19.1% of patients.
The stroke chameleon patients were identified from among 2200 acute ischaemic stroke patients admitted to a single centre over 8.25 years. Richoz et al stress that, had they been correctly diagnosed, 23.4% of the stroke chameleon patients would have been eligible for thrombolysis.
Misdiagnosis had consequences for patient outcomes. Significantly fewer stroke chameleon patients achieved a favourable 12-month outcome, at 50.0% versus 61.6% of correctly diagnosed patients, and they were more likely to die, at 30.4% versus 19.4%, and to have a recurrence, at 13.3% versus 9.9%.
Most independent predictors of misdiagnosis were indicative of mild stroke in younger patients with a low-risk profile. Pre-existing use of lipid-lowering drugs and the presence of eye deviation reduced the risk by 70% to 80%, and the risk of misdiagnosis also declined with older age and higher diastolic blood pressure.

The researchers call the tendency to misdiagnose patients with a low-risk profile “understandable”, but say “it shows the importance of educating medical personnel of the possibility of stroke in young patients with acute, unexplained neurologic symptoms.”
Cerebellar stroke was 3.78-fold more likely to be misdiagnosed than other strokes, in line with previous studies.
Many stroke chameleon patients had low National Institutes of Health Stroke Scale scores, but a group had very high scores, of around 25 to 35, and unexplained decreased level of consciousness was a frequent misdiagnosis, given to 21.3% of patients. Eleven patients presented in a stupor or coma, mostly because of basilar artery occlusion.
“This presentation may mislead physicians to suspect a metabolic, toxic, or anoxic encephalopathy rather than stroke”, writes the team in Neurology.
Even brain imaging did not always prevent misdiagnosis; indeed, it contributed to the wrong diagnosis in 40.4% of the patients. In nine patients, noncontrast computed tomography (CT) findings were misinterpreted, with subtle, early ischaemic changes often overlooked, and 10 patients had no changes, leading to the exclusion of stroke as a diagnosis.
The team therefore advises “the more systematic use” of more sensitive imagining techniques such as multimodal CT and magnetic resonance imaging.