Early Identification and Enhanced Pathway Efficiency for Acute Stroke

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Background

Effective emergency care for stroke requires rapid identification and transfer to a specialist facility for time-critical treatments. However, there are many challenges including the relative inaccuracy of suspected stroke identification by emergency medical services, the lack of point of care diagnostic tests, the distance to travel before direct specialist review is possible, and the overall complexity of the acute clinical pathway. Consequently, there are many patients who receive treatment after a delay or not at all, and other patients with non-stroke ‘mimic’ conditions who are inappropriately transferred to a specialist unit and may even receive unnecessary treatment.

This topic will focus upon the assessment and care pathway process leading up to specialist treatment, in order to collect evidence showing how efficiency of care delivery and services could be improved. Research settings will include ambulances, emergency departments, and specialist units. There are increasing examples of different patient pathways for faster delivery of emergency treatments (e.g. direct admission versus ‘drip and ship’ for thrombectomy treatment), but clinical identification processes are inefficient and many patients who are suitable for treatment are not identified early, whilst others with non-stroke ‘mimic’ conditions are misdirected to specialist centers. There are many clinical assessment scores to help non-specialists with identification, but evidence is still lacking about their real performance and the overall cost-effectiveness. Mobile stroke units may be helpful in suitable settings that can afford them, but evidence is still needed for their value in the thrombectomy era. Point of care diagnostics may be pivotal in developing efficient pathways, and there are an increasing number of promising biomarkers already developed through biobank and exploratory clinical studies, but evidence is still required for their use in the real world within the context of the whole suspected stroke population.

This Research Topic will include reports which relate to:
• Clinical identification of suspected stroke and stroke subtypes (e.g. large vessel occlusion)
• Point of care diagnostics (i.e. data collected prospectively during care) in later stages of clinical development
• Evaluation of telemedicine applications and other technologies which assist with communication and patient assessment during processing by emergency medical services
• The experience of care received by stroke mimic conditions
• Overall efficiency of well-defined emergency stroke care pathways which enable comparison to another defined pathway

We will consider articles of different types including original systematic reviews, observational studies (research and service evaluation), pathway modeling using primary data, and interventional trials. We will not include discovery science (e.g. animal experiments, exploratory analysis of human biobank samples, and pre-clinical application of biomarkers), small collections of case reports, or studies which undertake hypothetical modeling of service performance. We will consider diagnostic accuracy evaluation of biomarkers where evidence already exists that a measurable change in a relevant population indicates a strong probability of an important clinical state. All submissions should have a direct link to clinical care delivery during the prehospital and / or early hospital phase.

We would like to acknowledge that Dr. Bronwyn Tunnage, Auckland University of Technology, has acted as a coordinator and has contributed to the preparation of the proposal for this Research Topic.

Keywords: Stroke, Emergency Medical Services, Diagnosis, Telemedicine, Biomarker

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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