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Simulation-based team-training in acute stroke: Is it safe to speed up?
Liv Jorunn Høllesli1,2, Soffien Chadli Ajmi3,4, Martin W Kurz3,5
1Stavanger Medical Imaging Laboratory (SMIL), Department of Radiology, Stavanger University Hospital, Stavanger, Norway.
Brain and Behavior
|November 23, 2022
Summary
Simulation training for acute ischemic stroke (AIS) teams accelerated treatment but increased stroke mimics, particularly peripheral vertigo cases. No serious harm from intracranial hemorrhage (ICH) occurred in these stroke mimics.
Area of Science:
- Neurology
- Medical Education
- Emergency Medicine
Background:
- Rapid treatment with intravenous thrombolysis (IVT) is critical for acute ischemic stroke (AIS) outcomes.
- Simulation-based team training was implemented to improve stroke treatment times.
- The study investigated potential unintended consequences of this training, specifically an increase in stroke mimics (SMs) and harm from intracranial hemorrhage (ICH).
Purpose of the Study:
- To assess if faster IVT times due to simulation training led to a higher proportion of SMs among presumed AIS patients.
- To determine if SM patients treated with IVT experienced harm from ICH.
Main Methods:
- Prospective registration of AIS patients treated with IVT from 2015-2020.
- Introduction of weekly in situ simulation-based team training in 2017.
- Analysis of SM proportion and symptomatic ICH (sICH) in IVT-treated patients before and after training.
Main Results:
- The proportion of IVT-treated patients diagnosed as SMs significantly increased post-training (15.9% vs. 24.4%).
- Peripheral vertigo was the only SM subgroup that significantly increased (2.5% vs. 8.6%).
- No symptomatic ICH occurred in IVT-treated SM patients; two experienced asymptomatic ICH after training.
Conclusions:
- Simulation training for acute stroke teams is associated with an increased diagnosis of peripheral vertigo as a stroke mimic among IVT-treated patients.
- The proportion of other stroke mimics did not significantly change.
- No severe harm (sICH) was observed in IVT-treated stroke mimics.
