Clinical needs assessment acute neurologic diagnostic dilemma
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Clinical Needs Assessment : Acute Neurologic Diagnostic Dilemma. Background. Patients with different types of acute neurological injury may present with similar clinical findings.

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Clinical Needs Assessment : Acute Neurologic Diagnostic Dilemma

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Clinical needs assessment acute neurologic diagnostic dilemma

Clinical Needs Assessment : Acute Neurologic Diagnostic Dilemma

POC-CENT (Univ. of Cincinnati)


Background

Background

  • Patients with different types of acute neurological injury may present with similar clinical findings.

    • A focal neurological finding may help localize the location, but it may not help identify the cause. For example, a patient may have an altered mental status and right sided weakness due to an :

      • Ischemic stroke

      • Intracranial hemorrhage

      • Trauma

      • Seizure with post-ictal weakness.

    • Knowing the cause guides treatment

POC-CENT (Univ. of Cincinnati)


Incidence of acute neurological injuries

Incidence of Acute Neurological Injuries

  • In the US annually there are

    • 800,000 acute strokes

      • 15% are hemorrhagic, of which 33% worsen after presentation to the hospital

    • 1.7 million traumatic brain injuries

    • 2 million patients with epilepsy

      • 13 – 49 %  can evolve into status epilepticus or non-convulsive seizures.

  • Progression of the initial injury contributes to longer hospitalization and worse outcomes

POC-CENT (Univ. of Cincinnati)


Mortality trends over 5 decades for top 3 killers

Mortality trends over 5* decades for top 3 Killers

POC-CENT (Univ. of Cincinnati)


Mortality trends over 5 decades for top 10 killers

Mortality trends over 5* decades for top 10 Killers

POC-CENT (Univ. of Cincinnati)


Nih research funding allocation for selected conditions

NIH Research Funding Allocation for Selected Conditions

POC-CENT (Univ. of Cincinnati)


Impact of early intervention

Impact of Early Intervention

  • Acute stroke

    • Treatment with r-tPA within 4.5 hours after symptom onset has shown significant improvement in outcomes.

  • Intracerebral hemorrhage/contusion (stroke/TBI)

    • Controlling expansion can prevent surgery, hasten rehabilitation, and minimize long term deficits.

  • Seizures

    • Recurrent/prolonged seizures produce neuronal damage with long term cognitive and behavioral effects.

POC-CENT (Univ. of Cincinnati)


Impact of early diagnosis

Impact of Early Diagnosis

  • Currently differentiation among these acute neurological emergencies requires:

    • Transportation to a medical facility; CT or MRI scanning; and / or EEG monitoring capabilities

    • This takes time & contributes to treatment delay!

  • Rapid diagnosis of the neurological emergency in the field, Emergency Department or bedside could facilitate urgent care & improve patient outcomes

    • Unfortunately, existing technologies are not meeting this need for urgent point-of-care information

POC-CENT (Univ. of Cincinnati)


Original survey results

Original Survey Results

  • Surveys taken from

    • Society for Neuroscience Meeting; Neurology Resident Conference; Neurocritical Care Society Conference; DOD INTRuST Meeting

  • Total 133 Responses

    • 54 (40.6%) from Medical Personnel

    • Medical Personnel: Broad Range of Specialties

      • Neurointensivists●Neuro ICU Nurses

      • Neurologists ●Emergency Medicine Physicians

      • Neurosurgeons●Neuro Pharmacologists

      • Residents / Students● Psychologists

    • Non Clinical responders

      • Research scientists & Graduate students

POC-CENT (Univ. of Cincinnati)


Clinical conditions that would most benefit from poc

Clinical Conditions that Would Most Benefit from POC

  • Conditions: Traumatic Brain Injury, Ischemic Stroke,

    Hemorrhagic Stroke, Seizures (ie, status epilepticus)

    • Neurocritical Care Clinicians are particularly interested in the development of POC technologies in these areas

POC-CENT (Univ. of Cincinnati)


Locations for poc testing

Locations for POC Testing

Sub-analysis of 58 surveys (54 clinicians)

Asked what locations should be priority for POC testing

33 responses (57%)

POC-CENT (Univ. of Cincinnati)


Suggestions for specific poc needs

Suggestions for Specific POC Needs

Sub-analysis of 58 surveys (54 clinicians)

Asked to suggest specific POC needs

39 responses (67%); 23 topics proposed, top 5 were:

POC-CENT (Univ. of Cincinnati)


Rfa solicitation

RFA Solicitation

  • The role of the Center is to communicate user-based clinical needs and facilitate linking POC technologies to the right users.

    • Potential clinical settings: field use by EMT/EMS; Pre-hospital/urgent care; Emergency Department; Neuro ICU

  • Focus on diagnostic indicators for detection of acute neurological emergencies

    • Non-convulsive seizures; differentiation between hemorrhagic & ischemic stroke; cerebral contusions

    • Technologies to simplify / provide diagnostic surrogates.

      • May include lab on a chip & transdermal measures

POC-CENT (Univ. of Cincinnati)


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