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Clinical Needs Assessment : Acute Neurologic Diagnostic Dilemma

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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  1. Clinical Needs Assessment : Acute Neurologic Diagnostic Dilemma POC-CENT (Univ. of Cincinnati)

  2. 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)

  3. 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)

  4. Mortality trends over 5* decades for top 3 Killers POC-CENT (Univ. of Cincinnati)

  5. Mortality trends over 5* decades for top 10 Killers POC-CENT (Univ. of Cincinnati)

  6. NIH Research Funding Allocation for Selected Conditions POC-CENT (Univ. of Cincinnati)

  7. 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)

  8. 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)

  9. 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)

  10. 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)

  11. 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)

  12. 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)

  13. 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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