Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Iris Grunwald, Dundee University, Scotland, UK
- Second opponent: Professor Friedrich Martin Wilhelm Kurz, Stavanger University Hospital, Norway
- Third member and chair of the evaluation committee: Professor Kjetil Retterstøl, Faculty of Medicine, University of Oslo
Chair of the Defence
Professor Petter Laake, University of Oslo
Principal Supervisor
Pro-Rector of Research and Dissemination Kristi Grønvold Bache, Østfold University College, Researcher, Faculty of Medicine, Institute of Basic Medical Sciences
Summary
Acute stroke treatment is utterly time dependent. The treatment effect is greatest in the first hour after symptom onset (the golden hour), and even a few minutes reduction in time to treatment leads to better outcomes.
Objectives of this thesis were to investigate if acute stroke treatment in a mobile stroke unit (MSU), which is an ambulance equipped with a CT scanner and a physician-based ambulance team, was time saving, safe and cost effective compared to standard care. The hypothesis was that MSU care reduced time to thrombolysis with at least 15 minutes. Another objective was to explore if paramedics could be trained to perform an accurate and time efficient National Institutes of Health Stroke Scale (NIHSS) scoring in the field.
In a prospective intervention study, 440 suspected stroke patients were included. The MSU model reduced time to treatment with 17 minutes and increased both the thrombolytic and golden hour rates. A health economic analysis showed that MSU care was potentially cost-effective when at least 260 patients were treated per year. Results from a prospective cohort study of 63 paramedics trained in doing NIHSS, showed that the paramedics could use NIHSS as an accurate and time efficient clinical tool.
In conclusion, MSU care by a physician-based ambulance team saves important time for stroke patients and is potentially cost-effective in densely populated areas. Training paramedics in using NIHSS enables a quantifiable clinical examination of stroke patients in the field and creates a common language along the stroke care chain.
Additional information
Contact the research support staff.