Choice of Initial Brain Imaging in Patients with Suspected Acute Stroke: STROKE69, a Population-Based Study.

BACKGROUND: In patients with suspected stroke, brain imaging is recommended in the acute phase for appropriate management and treatment. Both computed tomography (CT) and magnetic resonance imaging (MRI) are considered reasonable choices for initial brain imaging. When both techniques are available, choosing one or the other might be associated with specific factors related either to patients, stroke symptoms, and severity or management organization. METHODS: The study was performed within the STROKE 69 database, a population-based cohort of all adult patients with suspected stroke admitted in one of the emergency departments (ED), primary stroke center, or stroke center of the Rhône County, from November 2015 to December 2016. Patients were included if they were admitted within 24 h following either symptom onset or last known normal. To identify factors potentially associated with the choice of initial brain imaging, a multivariate logistic regression was performed. RESULTS: Among the 3,244 patients with suspected stroke enrolled in the STROKE69 cohort, 3,107 (95.8%) underwent brain imaging within the first 24 h after admission. Among those 74.6% underwent CT as initial imaging while 25.4% had an MRI. In multivariate analyses, several factors were associated with a lower probability of having an MRI as initial brain imaging versus CT. These were either patient characteristics: older age (>80 years old, OR 0.39 [95% CI 0.28-0.54]), preexisting disability (OR 0.55 [95% CI 0.36-0.84]), use of anticoagulants (OR 0.52 [95% CI 0.33-0.81]), stroke characteristics: stroke of unknown onset (OR 0.42 [95% CI 0.31-0.58]) or factors associated with overall management: onset-to-door time (>6 h, OR 0.38 [95% CI 0.23-0.60]), initial admission to ED (OR 0.02 [95% CI 0.02-0.04]) or intensive care unit (OR 0.01 [95% CI 0.001-0.08]), personal transport (OR 0.66 [95% CI 0.45-0.96]), and admission during working hours (OR 0.65 [95% CI 0.51-0.84]). CONCLUSIONS: Besides CT or MRI availability, a number of other parameters could influence the choice of first imaging in case of stroke suspicion. These are related to patient characteristics, type of stroke symptoms, and type of organization.

Stay and play eFAST or scoop and run eFAST? That is the question!

UNLABELLED: The concept that ultrasonography could be interesting in the prehospital setting and during the transfer of traumatized patients is not new. Paradoxically, there is a lack of description of routine use of ultrasonography in emergency ambulances. The aim of this study was to compare the feasibility and efficiency of an extended focused assessment sonography for trauma (eFAST) examination performed on-site, during the patient's transfer, or both. MATERIALS AND METHODS: From February 2010 to June 2012, 30 prehospital emergency physicians were divided randomly into 3 groups. Group 1 performed an ultrasound examination on-site; group 2, during patient transfer; and group 3, in both settings. The eFAST examination was systematically performed in all severe traumas. RESULTS: Ninety-eight patients were included. Forty-four eFAST examinations were performed on-site only; 33, only during transport; and 21, in both settings. The feasibility was 95.4%, 93.9%, and 95.2%, respectively, and efficiency, 95%, 97%, and 100%, respectively. There was no significant difference in performance or duration whether the examination was performed on-site, during the transfer, or both (w = 0.68). Last but not least, in 2 cases in group 3, the second examination carried out during transfer showed new results with the occurrence of intraperitoneal effusion in one case and a pleural effusion in the other. CONCLUSIONS: The eFAST examination can provide reliable and important information in the initial evaluation of traumatized patients. It can be completed either on-site or during patient transfer. Its feasibility and efficiency are similar to that done in intensive units, especially if the examination is repeated.

2-point ultrasonography to confirm correct position of the gastric tube in prehospital setting.

UNLABELLED: X-ray remains the "gold standard" test to control the gastric tube (GT) position. The aim of this study is to estimate the diagnostic accuracy of a 2-point ultrasonography to confirm GT placement in the prehospital setting. METHOD: The emergency physician performed an ultrasound examination during GT insertion. The aim was to determine whether or not the GT could be viewed in the esophagus and/or in the stomach. RESULTS: Thirty-two intubated patients were included. In 100% of cases, the GT was instantly identified by ultrasound at esophagus and in 62.5% at stomach. In 6 cases, the GT was not seen in the stomach, but the injection of air through the GT allowed to confirm intragastric position in 2 cases. In the 4 other cases, no dynamic fogging was observed. In hospital X-ray control confirmed the correct positioning of 28/32. CONCLUSION: The 2-point ultrasonographic live control of the GT position has a better sensitivity and a much higher specificity than the syringe test but similar to the xiphoid ultrasound control. However, our method allows to show the GT in the esophagus and to use the dynamic ultrasound fogging to reveal an intragastric position that was not obvious with the common techniques.