WSO - January 2024 - 78

78
International Journal of Stroke 19(1)
infrastructural assessment and limitations. The objective of
this study was to undertake a situational analysis of the current
status of acute stroke care in select medical colleges in
India.
Methodology
Study design
The following study was undertaken as part of the baseline
assessment of the ongoing IMPETUS stroke study.10
IMPETUS stroke is a multicentric, prospective, multiphase,
mixed-methods, quasi-experimental implementation study,
comprising three phases. The study was initiated in October
2021. Phase 1 is the pre-implementation phase, wherein a
baseline survey assessment of the existing components of
stroke care was performed. This study reports the existing
infrastructure for stroke care among the study sites during
the pre-intervention phase. During phase I, baseline data
are collected on patients in a predefined structured case
record form and focused group discussions were held to
understand barriers and facilitators of stroke care. This is
followed by the implementation phase where main intervention
is periodic education and training of the staff, meetings
with the site administrators, and education and training
of caregivers. Following this implementation phase, data
collection is continued to observe the level of implementation
and sustainability. The outcomes of implementation
shall be assessed on defined indicators of stroke care, mortality,
and disability.10
Study setting
We conducted the study in the collaborating 22 medical
colleges and hospitals stretched across 14 different cities
from 12 different states of India. All medical colleges are
tertiary medical centers situated either in district headquarters
or the state capitals.
Study participants
We sought responses to these questions from the neurology
or medicine faculty of all study sites involved in the
IMPETUS stroke study.
Study tool
The authors (R.B. and P.H.) formulated 85 questions after
multiple rounds of discussions which seemed important
and reasonable for the stroke care pathways in a hospital
(supplemental material). We also reviewed the World
Stroke Organization (WSO) action plan for optimizing
stroke outcomes, the recommendation of the American
Stroke Association (ASA) for the establishment of stroke
systems of care and European expert survey to assess the
main components of stroke unit care.11-13
International Journal of Stroke, 19(1)
Table 1. Stroke recognition and emergency area infrastructure.
Stroke helpline
Ambulance service 24 × 7
Stroke pre-notification
Stroke trained physician in the emergency
area
Neurosurgeon availability
Neurologist on call 24 × 7
NIHSS assessment in the emergency area
NCCT availability 24 × 7
CT angiography 24 × 7
MRI brain 24 × 7
DSA availability
ECG availability
3/22 (14%)
18/22 (82%)
5/22 (23%)
6/22 (27%)
19/22 (86%)
15/22 (68%)
13/22 (59%)
22/22 (100%)
13/22 (59%)
9/22 (41%)
9/22 (41%)
19/22 (86%)
NIHSS: National Institute of Health Stroke Scale; NCCT: non-contrast
computed tomography; CT: computed tomography; MRI: magnetic
resonance imaging; DSA: digital subtraction angiography; ECG:
electrocardiogram.
Study variables and mode of question
administration
Questions were sent through email-based electronic forms
to neurology and medicine consultants from 22 different
medical colleges via email. Questions were directed toward
human resources and infrastructure involved in stroke care,
emergency setting and in-hospital care, secondary prevention
strategies, and discharge planning of stroke patients.
Ethical issues: Study has been given ethical approval by the
Institute Ethics Committee of the All India Institute of
Medical Sciences, New Delhi, India (IEC-92/06.3.2020).
The study adheres to the STROBE observational study
guidelines.14
Results
All sites completed the questionnaire. The responses were
provided by 19 neurologists and 3 internal medicine specialists.
We observed a lack of stroke helpline numbers
available for community (3/22;14%) among study sites.
Although ambulance services are present in 18/22 (82%)
hospitals, stroke prenotification systems were available in
only 5/22 (23%) hospitals (Table 1). Non-contrast computed
tomography (NCCT) facilities were available in all
hospitals. However, other imaging modalities were available
at a limited time of the day. Although on-call neurologists
are available in 15/22 (68%) hospitals, only 6/22
(27%) hospitals have stroke-trained physicians available in
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