What are the images used to diagnose and assess suspected strokes?: A systematic literature review of care in four European countries

ABSTRACT

Introduction: The cost-effectiveness of clinical interventions is often assessed using current care as comparator. However, evidence suggests practice variation in stroke imaging across countries. For the purpose of feeding into cost-effectiveness analysis, this research aims to describe the patterns of stroke imaging, examine practice variations across countries and, as such, obtain results reflecting current care.

Areas covered: A systematic literature review was conducted to identify original studies reporting the imaging workup used in acute stroke care in clinical practice in Hungary, Germany, Sweden and the UK. Information regarding the type and frequency of stroke imaging was analysed. Computed Tomography (CT) was reported as the main diagnostic imaging modality used in stroke care (78–98% across patient profiles and time periods). This review revealed patterns that were not observed in individual studies. Comparisons of UK studies revealed considerable variations in the proportion of scanned patients and timing of imaging.

Expert commentary: While the evidence about thrombectomy is difficult to translate in clinical practice, the evidence regarding the optimal imaging approach to diagnose stroke patients is lacking. The heterogeneity in stroke imaging reinforces the need to compare the quality of stroke care within and between countries.

KEYWORDS:

• Stroke
• clinical practice variation
• diagnosis
• imaging
• Europe

Acknowledgment

We are immensely grateful to Andre Peeters (Department of neurology, stroke unit Cliniques Universitaires St-Luc, Avenue Hippocrate, 10, 1200 Brussels – Belgium) for his contribution to the final version of the manuscript. Any remaining errors or omissions remain the sole responsibility of the authors.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplemental material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by the European Union’s Horizon 2020 research and innovation programme under grant agreement No 643694.