WSO - January 2024 - 79

Salunke et al.
79
Table 2. Hyperacute stroke care.
Rapidly performed during the acute stroke evaluation in the
emergency
(a) Blood sugar
(b) Blood pressure
(c) Level of consciousness
(d) ECG
(e) Point of care INR
IVT
(a) Overall availability of IVT
(b) 24 × 7 availability of IVT
(c) IVT with only TPA
(d) IVT with only TNK
(e) IVT with TPA or TNK
(f) Free of cost IVT
EVT
(a) Overall availability of EVT
(b) 24 × 7 availability of EVT
(c) Free-of-cost EVT
Post-thrombolysis monitoring
Decompressive craniectomy services
Hematoma evacuation
6/22 (27%)
4/22 (18%)
2/22 (9.1%)
13/22 (59%)
13/22 (59%)
11/22 (50%)
INR: international normalized ratio; IVT: intravenous thrombolysis; TPA:
tissue plasminogen activator; TNK: Tenecteplase; EVT: endovascular
therapy (mechanical thrombectomy).
the emergency (Table 1). Initial evaluation with blood
sugar, blood pressure, and level of consciousness assessment
is being done in almost all hospitals. However, routine
National Institute of Health Stroke Scale (NIHSS)
assessment is being done in only 13/22 (59%) during emergency
evaluation (Table 1).
Intravenous thrombolysis (IVT) is performed in 20/22
(91%) hospitals among which 17/22 (77%) are providing it
free of cost. Tissue plasminogen activator (TPA) is the most
common agent used for IVT (Table 2). Endovascular therapy
(EVT) services are available in 6/22 (27%) of the hospitals
but only two hospitals are providing it free (Table 2).
Lifesaving neurosurgical processes like decompressive
craniectomy, 13/22 (59%), and hematoma evacuation,
11/22 (50%), are being performed in limited hospitals
(Table 2). All hospitals have availability of CT angiography,
carotid Doppler, and two-dimensional (2D)-echo
(Table 3). Although Holter monitoring was available in all
20/22 (91%)
17/22 (77%)
6/20 (27%)
4/20 (20%)
10/20 (50%)
14/20 (70%)
22/22 (100%)
21/22 (95%)
22/22 (100%)
19/22 (86%)
11/22 (50%)
Table 3. Inpatient stroke care infrastructure.
Availability of stroke unit
Availability of stroke team
Neurosurgery services availability
Patient as to nurse ratio (>4:1)
NCCT availability
CT angiography availability
MRI brain availability
Holter availability in the hospital
Holter use for ischemic stroke
Carotid doppler availability in the hospital
Carotid doppler use for ischemic stroke
Availability of motorized bed
Availability of air mattress
Availability of SpO2 monitors
Availability of cardiac monitors
Provision of medications by the hospitals
(a) Antiplatelets
(b) Anticoagulants heparin
(c) Anticoagulants oral
(d) Mannitol
(e) Antihypertensive drugs
(f) Statins
7/22 (32%)
8/22 (36%)
19/22 (86%)
15/22 (68%)
22/22 (100%)
22/22 (100%)
21/22 (95%)
18/22 (82%)
2/22 (9.1%)
22/22 (100%)
18/22 (82%)
19/22 (86%)
18/22 (82%)
22/22 (100%)
21/22 (95%)
21/22 (95%)
21/22 (95%)
18/22 (82%)
21/22 (95%)
21/22 (95%)
21/22 (95%)
ECG: electrocardiogram; NCCT: non-contrast computed tomography;
CT: computed tomography; MRI: magnetic resonance imaging.
centers, its use for ischemic stroke evaluation was only
done in 2/22 (9.1%). Routine swallow assessment is being
done around three-fourths of the hospitals. In 19/22 (86%)
hospitals, blood pressure monitoring is done at least twice
daily (Table 4). Pneumatic compression and/or heparin is
routinely used in 18/22 (82%) hospitals for deep vein
thrombosis (DVT) prevention (Table 4). At the time of discharge,
all hospitals are able to do risk profiling for diabetes
mellitus, hypertension, heart disease, and smoking (Table
4). However, etiology identification (ischemic stroke subclassification)
at the time of discharge is mentioned regularly
in only 13/22 (59%) (Table 4).
Discussion
Public hospitals face challenges in providing comprehensive
care to acute stroke patients. This includes pre-hospital,
International Journal of Stroke, 19(1)
WSO - January 2024

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