Advanced

Video Analysis Supporting Stroke Assessment within the Prehospital Care

Anzén, Emma LU (2018) BMEM01 20181
Department of Biomedical Engineering
Abstract
Sweden, as well as the rest of the world has an increasing life-expectancy creating higher demands on the healthcare providers and on the quality of healthcare. Stroke is the third leading cause of death in Sweden. Prehospital stroke assessment is completed as rapid assessments by paramedics through the use of different stroke scales. Current stroke scales exclusively include qualitative data which results in a low sensitivity of the scales, thereby creating an over-triage of patients. Interrater variability is high, meaning different professionals conclude different assessments for the same patient.

The time until treatment after a stroke is essential for the outcome. The faster a diagnosis can be determined the faster the patient can... (More)
Sweden, as well as the rest of the world has an increasing life-expectancy creating higher demands on the healthcare providers and on the quality of healthcare. Stroke is the third leading cause of death in Sweden. Prehospital stroke assessment is completed as rapid assessments by paramedics through the use of different stroke scales. Current stroke scales exclusively include qualitative data which results in a low sensitivity of the scales, thereby creating an over-triage of patients. Interrater variability is high, meaning different professionals conclude different assessments for the same patient.

The time until treatment after a stroke is essential for the outcome. The faster a diagnosis can be determined the faster the patient can receive care. The paramedics have a large impact on the time from first care contact until diagnosis; therefore a correct stroke assessment is of immense importance.

The aim of the thesis is to create a conceptual clinical support system to reduce the over-triage and interrater variability. The conceptual system produced is referred to as the suggested system. The suggested system includes video analysis of stroke patients in order to establish a more equal, patient oriented and knowledge based care.

The suggested system detects four important parameters of stroke assessment. The parameters are extremity motor skills, facial-, eye- and head-movements. The four parameters cover eleven out of fifteen factors currently used to perform a stroke assessment at a hospital. The stroke scales used at hospitals are more extensive and detect larger varieties of strokes than prehospital stroke scales. The use of more extensive and accurate stroke scales in the prehospital area has previously been too time-consuming to complete.

The output of the suggested system visualises an augmented reality that enhances the assessed parameters resulting in a positive stroke assessment, which provides support to paramedics and on-call doctors.

The suggested system includes hardware and software placement and requirements as well as complexities with implementing new technologies and solutions in the prehospital care. Further discussed is the understanding of the single user as well as the integration of a novel system. The collaboration between hospitals and the prehospital environment is crucial for determining consequences, possibilities and difficulties in enhancing the current pathways of stroke assessment. (Less)
Popular Abstract
Technology Improves Stroke Assessment

Stroke is the third leading cause of death in Sweden, the leading cause of immobilization in the world and the most expensive condition treated by the Swedish healthcare. An initial assessment of stroke is often completed by paramedics in the ambulance care, also called the prehospital care. Few quantitative signs of stroke are known and many stroke mimicking conditions are present. Based on this, the aim has been to examine the possibilities of decreasing the interrater variability and over-triage by implementing digital video analysis supporting the prehospital stroke assessment.

By including video analysis in prehospital stroke assessment eight additional parameters for stroke detection can be... (More)
Technology Improves Stroke Assessment

Stroke is the third leading cause of death in Sweden, the leading cause of immobilization in the world and the most expensive condition treated by the Swedish healthcare. An initial assessment of stroke is often completed by paramedics in the ambulance care, also called the prehospital care. Few quantitative signs of stroke are known and many stroke mimicking conditions are present. Based on this, the aim has been to examine the possibilities of decreasing the interrater variability and over-triage by implementing digital video analysis supporting the prehospital stroke assessment.

By including video analysis in prehospital stroke assessment eight additional parameters for stroke detection can be partly or fully identified. The current prehospital stroke assessment tests three parameters, to use more parameters has previously been determined as too time-consuming. Including more parameters while not affecting the time will increase quality and precision of stroke assessment.

The most important parameter for stroke recovery is the time from symptom onset until care is given. A faulty initial assessment of stroke has been seen to increase the time and thereby directly worsen the outcome of stroke recovery. The initial assessment determines where the patient is transported and what level of care is given. Treatment of stroke can not start before a diagnosis is made at a hospital due to the need of CT- and MR-imaging.

Functions affected by stroke are usually activities of daily living. With a growing and an aging population, better resources to assess stroke are needed. Traditional stroke assessment is completed by healthcare professionals through the use of checklists, called stroke scales. There are no vital signs or other measurements that indicate a stroke and therefore current stroke scales consists of qualitative data. Current stroke scales have low sensitivity which creates an over-triage, resulting in sending too many non-sick patients to the hospital. Interrater variability is high, meaning different professionals conclude different assessments for the same patient.

The suggested system aims to create an augmented reality clinical support system to reduce the current over-triage of prehospital stroke assessment. The suggested system should create a more equal, patient oriented, cost-effective and knowledge based care. It would provide a support for paramedics and on-call doctors as well as reducing the interrater variability of stroke assessment. Thoroughly discussed are also complexities with implementing new technologies and solutions in the prehospital care as well as the collaboration between hospitals and the Swedish prehospital care.

The methods used to derive the conclusions are interviews, observations and literature studies. The area of video analysis for stroke assessment is a novel area with no clinically implemented solutions. Implementing video analysis as a support system is a step in the digitalization of healthcare including e-health and ensuring the healthcare professionals and patients best interest.

By including a video-monitoring system patients may express a loss of privacy and distress of being monitored, but the information withheld by the system is entirely used to ensure the safety of the patient. Parameters improving the prehospital assessment have been discussed and suggestions of hardware placements are given.

The suggested system is sought for by users and it is possible to create a solution that could be tested in clinical trials, however, all issues with prehospital stroke assessment have not been solved. The next step is to create a system implemented in a clinical environment. Other areas of use could be the in-house healthcare, health centres and remote care facilities. (Less)
Please use this url to cite or link to this publication:
author
Anzén, Emma LU
supervisor
organization
course
BMEM01 20181
year
type
H2 - Master's Degree (Two Years)
subject
keywords
Augmented reality, FAST, NIHSS, prehospital care, quantitative measurements, stroke, telestroke, video analysis
language
English
additional info
2018-09
id
8942861
date added to LUP
2018-06-15 10:32:43
date last changed
2018-06-15 10:32:43
@misc{8942861,
  abstract     = {Sweden, as well as the rest of the world has an increasing life-expectancy creating higher demands on the healthcare providers and on the quality of healthcare. Stroke is the third leading cause of death in Sweden. Prehospital stroke assessment is completed as rapid assessments by paramedics through the use of different stroke scales. Current stroke scales exclusively include qualitative data which results in a low sensitivity of the scales, thereby creating an over-triage of patients. Interrater variability is high, meaning different professionals conclude different assessments for the same patient.

The time until treatment after a stroke is essential for the outcome. The faster a diagnosis can be determined the faster the patient can receive care. The paramedics have a large impact on the time from first care contact until diagnosis; therefore a correct stroke assessment is of immense importance.

The aim of the thesis is to create a conceptual clinical support system to reduce the over-triage and interrater variability. The conceptual system produced is referred to as the suggested system. The suggested system includes video analysis of stroke patients in order to establish a more equal, patient oriented and knowledge based care. 

The suggested system detects four important parameters of stroke assessment. The parameters are extremity motor skills, facial-, eye- and head-movements. The four parameters cover eleven out of fifteen factors currently used to perform a stroke assessment at a hospital. The stroke scales used at hospitals are more extensive and detect larger varieties of strokes than prehospital stroke scales. The use of more extensive and accurate stroke scales in the prehospital area has previously been too time-consuming to complete. 

The output of the suggested system visualises an augmented reality that enhances the assessed parameters resulting in a positive stroke assessment, which provides support to paramedics and on-call doctors.

The suggested system includes hardware and software placement and requirements as well as complexities with implementing new technologies and solutions in the prehospital care. Further discussed is the understanding of the single user as well as the integration of a novel system. The collaboration between hospitals and the prehospital environment is crucial for determining consequences, possibilities and difficulties in enhancing the current pathways of stroke assessment.},
  author       = {Anzén, Emma},
  keyword      = {Augmented reality,FAST,NIHSS,prehospital care,quantitative measurements,stroke,telestroke,video analysis},
  language     = {eng},
  note         = {Student Paper},
  title        = {Video Analysis Supporting Stroke Assessment within the Prehospital Care},
  year         = {2018},
}