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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT05991310
Registration number
NCT05991310
Ethics application status
Date submitted
27/07/2023
Date registered
14/08/2023
Date last updated
21/09/2023
Titles & IDs
Public title
Evaluating the Safety and Efficacy of Telemedicine Neurology Assessments on a Mobile Stroke Unit
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Scientific title
Evaluating the Safety and Efficacy of Telemedicine Neurology Assessments on a Mobile Stroke Unit
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Secondary ID [1]
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2023.110
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Ischemic Stroke
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Intracerebral Hemorrhage
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Condition category
Condition code
Stroke
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Haemorrhagic
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Stroke
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Ischaemic
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Neurological
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Other neurological disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Other interventions - Telemedicine Assessment by Remote Neurologist
Other interventions - In-Person Assessment by an Onboard Neurologist
Experimental: Telemedicine Assessment by Remote Neurologist - Following the initial assessment, the stroke nurse will activate the telemedicine video conference call and review the patient with the telemedicine neurologist. The telemedicine neurologist will perform a NIHSS with assistance from the stroke nurse, and this will be documented on the clinical records. Imaging will be evaluated remotely by the telemedicine neurologist. If there is a decision to administer thrombolysis, the stroke neurologist and nurse will discuss treatment with the patient or next of kin, where appropriate and able, to acquire assent in a timely manner.
Active comparator: In-Person Assessment by an Onboard Neurologist - Upon arrival on-scene, the MSU stroke nurse, neurologist, and paramedic will liaise with local ambulance services to obtain initial clinical details and perform an initial assessment. The NIHSS will be performed by the neurologist, and this will be documented on standardized clinical records. Imaging will be assessed at the console available within the ambulance. If there is a decision to administer thrombolysis, the stroke neurologist and nurse will discuss treatment with the patient or next of kin, where appropriate and able, to acquire assent in a timely manner.
Other interventions: Telemedicine Assessment by Remote Neurologist
Use of a telemedicine platform for a neurologist, remotely located, to assess a MSU patient, review imaging, and decide on the required treatments.
Other interventions: In-Person Assessment by an Onboard Neurologist
Traditional in-person assessment of a patient by a neurologist located onboard the MSU
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Intervention code [1]
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Other interventions
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Desirability of Outcome Ranking (DOOR) of: Safety, Scene-to-decision Treatment Times, and Resource Efficiency
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Assessment method [1]
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The odds that a random participant treated through a telemedicine assessment will have a more desirable DOOR scale outcome than a random participant treated by an onboard neurologist. Such a odds is referred to as the Win Ratio, as it reflects the odds of a random participant treated via telemedicine "winning" against a random participant treated via an onboard model in a direct one-to-one comparison.
The design evaluates, in order of importance: Safety, Scene-to-decision time metrics, Resource efficiency
If a participant in one treatment arm is achieving better safety than the comparator, this is defined as a "win" for that participant and a "loss" for the comparator. If there is no difference in safety, time to treatment decision is compared. If no clinically meaningful difference is observed, then resource utilization is compared. If there is no difference in resource utilization, the two participants are declared as tied for the overall outcome.
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Timepoint [1]
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See pre-specified outcome section for details
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Secondary outcome [1]
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On-scene to eyes-on-patient (for the neurologist)
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Assessment method [1]
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Timepoint [1]
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Time of Acute Assessment on the Mobile Stroke Unit (up to 2 hours from arrival on scene)
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Secondary outcome [2]
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On-scene to imaging
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Assessment method [2]
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Timepoint [2]
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Time of Acute Assessment on the Mobile Stroke Unit (up to 2 hours from arrival on scene)
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Secondary outcome [3]
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On-scene to imaging review by the neurologist
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Assessment method [3]
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Timepoint [3]
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Time of Acute Assessment on the Mobile Stroke Unit (up to 2 hours from arrival on scene)
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Secondary outcome [4]
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On-scene to definitive decision making
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Assessment method [4]
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Inclusive of the following: 1) Decision for thrombolysis, 2) Decision to refer for endovascular thrombectomy, 3) Decision to stand down case, or 4) Decision to transfer to stroke hospital (e.g. suspected stroke but unable to treat on MSU)
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Timepoint [4]
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Time of Acute Assessment on the Mobile Stroke Unit (up to 2 hours from arrival on scene)
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Secondary outcome [5]
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90-Day mRS
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Assessment method [5]
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Clinical outcomes for patients who receive thrombolysis on the MSU or are transferred to a comprehensive center for endovascular clot retrieval
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Timepoint [5]
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90 days (+/- 10 days from symptom onset)
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Eligibility
Key inclusion criteria
1. Adults >=18 years of age
2. Presenting within 24 hours of symptom onset or last known well.
3. Patients assessed by MSU without cancellation (either by the local ambulance team or by MSU) prior to attending the patient.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Attendance of the Melbourne MSU is deemed unnecessary by either the local paramedic team or the MSU team based on provided information prior to arrival on scene.
2. The patient presents significant medical or logistical challenges which greatly delay standard treatment.
3. Any other medical contraindication at the discretion of the investigator.
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Study design
Purpose of the study
Other
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
NA
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
21/08/2023
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
1/09/2024
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Actual
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Sample size
Target
270
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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Royal Melbourne Hospital Mobile Stroke Unit - Melbourne
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Recruitment postcode(s) [1]
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3050 - Melbourne
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Funding & Sponsors
Primary sponsor type
Other
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Name
Melbourne Health
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Address
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Country
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Ethics approval
Ethics application status
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Summary
Brief summary
The goal of this clinical trial is to compare a telemedicine neurologist staffing model to a traditional on-board model in patients being assessed for suspected acute stroke on a mobile stroke unit.
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Trial website
https://clinicaltrials.gov/study/NCT05991310
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Vignan Yogendrakumar, MD MSc
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Address
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Melbourne Health
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Nicola Parsons
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Address
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Country
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Phone
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0393427000
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Fax
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Email
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[email protected]
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Contact person for scientific queries
No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT05991310
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