Abstract Background and aims Early recognition of stroke during emergency calls is crucial for timely reperfusion treatment, but dispatcher diagnostic accuracy varies widely. Whether live video streaming between callers and dispatchers improves stroke recognition and care is unclear. This is a predefined substudy of the cluster-randomized CAM-VISION trial evaluated the effect of dispatcher access to live video on identification of stroke or transient ischemic attack (TIA) and prehospital management. Methods Dispatchers were randomized to use either live one-way video from callers’ smartphones or standard telephone communication. Prespecified outcomes were: (1) diagnostic performance for stroke/TIA using hospital-confirmed diagnoses as reference; (2) reperfusion treatment—intravenous thrombolysis (IVT) and/or endovascular therapy (EVT) among patients with acute ischemic stroke (AIS) and (3) direct admission to a stroke center. Analyses followed the intention-to-treat principles with cluster-robust variance estimation. Results Among 18,745 calls, 412 patients had a confirmed cerebrovascular diagnosis (326 strokes, 86 TIAs). Video streaming was used in 41.6% of cases. Sensitivity for stroke/TIA recognition was 73.4% with video versus 79.5% with telephone; specificity was 95.9% versus 94.5%. IVT rates were numerically higher with video but not statistically significant (incidence rate ratio 1.34; 95% CI 0.94–1.92; P = 0.11). Direct transport to stroke centers was similar (90.5% vs. 92.6%; P = 0.56). Use of highest urgency level dispatch was sigficantly lower in the video group. Conclusions Dispatcher access to live video did not significantly improve diagnostic accuracy for stroke or TIA but was associated with a non-significant increase in IVT and a reduced highest urgency level dispatch. Conflict of interest Rolf Blauenfeldt: nothing to disclose, Ulle Væggemose: nothing to disclose, Claus Ziegler Simonsen: nothing to disclose, Martin Faurholdt Gude: nothing to disclose.
Blauenfeldt et al. (Fri,) studied this question.
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