Introduction: Early prehospital identification of stroke and triage to the right level of care may result in more patients receiving acute treatment. Approximately 25% of patients in Denmark receive revascularisation after an acute stroke. Further, 20 % of patients with stroke are not being recognized by paramedics when assessed on scene in a telephone conference with the stroke centre. Accurate prehospital stroke identification is critical for treatment and patient outcomes. The National Institutes of Health Stroke Scale (NIHSS) is an established tool for assessing stroke severity, but it is not commonly used by paramedics. In this study, paramedics are using an app to assess the patient, guiding the paramedic through the NIHSS, while each step is documented in a short video, which is transferred to the centralized stroke center. Methods: A stepped wedge randomized trial is performed, with paramedics being the subject which is randomized. First, paramedics are enrolled in October 2024. Data collection is terminated in December 2025. A paramedic in an intervention cluster uses a mobile app for patients with suspected stroke, recording videos of patients. The app analyses the videos, highlighting potential stroke predictors. Recorded videos and NIHSS scores are transmitted to the stroke center for thrombolysis decision-making. In the control group, standard procedures are followed. Results: The primary outcome measure is for prehospital recognition of patients with acute stroke, defined as the proportion of patients accepted for stroke evaluation and discharged with a final stroke diagnosis. A power calculation yields that no less than 1200 patients will be enrolled in each arm of the trial for 95% power to detect a 5% improvement, with 85% sensitivity assumed in the control group. Conclusion: The results will show the intervention’s potential to improve stroke recognition rates and its ability to reduce on-scene times.
Blomberg et al. (Sun,) studied this question.