Appendix 1
International survey of diagnostic and management capabilities for acute stroke
QUESTIONS:
I. PHYSICIAN CHARACTERISTICS AND LOCATION1. Which country do you currently practice medicine in?
Afghanistan Dominican Republic Libya Sao Tome and Principe
Albania Ecuador Liechtenstein Saudi Arabia
Algeria Egypt Lithuania Senegal
Andorra El Salvador LuxembourgSerbia
Angola Equatorial Guinea Macedonia Seychelles
Antigua and
Barbuda Eritrea Madagascar Sierra Leone
Argentina Estonia Malawi Singapore
Armenia Ethiopia Malaysia Slovakia
Australia Fiji Maldives Slovenia
Austria Finland Mali Solomon Islands
Azerbaijan France Malta Somalia
Bahamas, The Gabon Marshall Islands South Africa
Bahrain Gambia, The Mauritania Spain
Bangladesh Georgia Mauritius Sri Lanka
Barbados Germany Mexico Sudan
Belarus GhanaMicronesia,
Federated States ofSuriname
Belgium Greece Moldova Swaziland
Belize Grenada Monaco Sweden
Benin Guatemala Mongolia Switzerland
Bhutan GuineaMontenegro
Syria
Bolivia Guinea-Bissau Morocco Taiwan
Appendix 1
Bosnia and
Herzegovina Guyana Mozambique Tajikistan
Botswana Haiti Namibia Tanzania
Brazil Holy See Nauru Thailand
Brunei Honduras Nepal Timor-Leste
Bulgaria Hungary Netherlands Togo
Burkina Faso Iceland New Zealand Tonga
Burma India Nicaragua Trinidad and Tobago
Burundi Indonesia Niger Tunisia
Cambodia Iran Nigeria Turkey
Cameroon Iraq Norway Turkmenistan
Canada Ireland Oman Tuvalu
Cape Verde Israel Pakistan Uganda
Central
African RepublicItaly Palau Ukraine
Chad Jamaica Panama United Arab Emirates
Chile Japan Papua New Guinea United Kingdom
China Jordan Paraguay United States
Colombia Kazakhstan Peru Uruguay
Comoros Kenya Philippines Uzbekistan
Congo (Brazzaville) Kiribati Poland Vanuatu
Congo (Kinshasa) Korea, North Portugal Venezuela
Costa Rica Korea, South Qatar Vietnam
Côte d'Ivoire Kosovo Romania Yemen
Croatia Kuwait Russia Zambia
Cuba Kyrgyzstan Rwanda Zimbabwe
Cyprus Laos Saint Kitts and Nevis Did not answer
Czech Republic Latvia Saint Lucia
Denmark LebanonSaint Vincent and
the Grenadines
Djibouti Lesotho Samoa
Dominica Liberia San Marino
Appendix 1
2. Which of the following categories best describes your qualifications (Please choose only one response)?
General Practitioner with no specialty training
Specialty training in Internal Medicine
Specialty training in Emergency Medicine
Specialty training in Neurology
Specialty training in Stroke or Vascular
Neurology
Others
Did not answer
3. After your primary medical qualification, for how many years have you been providing medical care to stroke patients?
Less than 5 years
6-10 years
More than 10 years
I don’t know
Did not answer
4. Approximately how many new patients with a stroke do you see each month?
1-5
6-10
10-30
More than 30
I don’t know
Did not answer
II. HOSPITAL CHARACTERISTICS AND INFRASTRUCTUREA. Hospital Characteristics
1. How many hospitals do you usually see stroke patients at?
1
2
3
4
5 or more
Did not answer
Appendix 1
2. What is the name and zip code of the hospitals where you see stroke patients at (up to 5)
Name of Hospital Country State/Province City/Town Zip Code
Hospital 1
Hospital 2
Hospital 3
Hospital 4
Hospital 5
3. Which of the following describes the hospitals that you most commonly see stroke patients at (up to 5 hospitals)?
a) Hospital 1Large Hospital (>500 beds)
Medium sized hospital (100-500
beds)
Small hospital (20-99 beds)
Very small hospital (<20 beds)
I don’t know
Did not answer
b) Hospital 2Large Hospital (>500 beds)
Medium sized hospital (100-500 beds)
Small hospital (20-99 beds)
Very small hospital (<20 beds)
Not applicable- I don’t see patients at any other
hospital
I don’t know
Did not answer
c) Hospital 3Large Hospital (>500 beds)
Medium sized hospital (100-500 beds)
Appendix 1
Small hospital (20-99 beds)
Very small hospital (<20 beds)
Not applicable- I don’t see patients at any other
hospital
I don’t know
Did not answer
d) Hospital 4Large Hospital (>500 beds)
Medium sized hospital (100-500 beds)
Small hospital (20-99 beds)
Very small hospital (<20 beds)
Not applicable- I don’t see patients at any other
hospital
I don’t know
Did not answer
e) Hospital 5Large Hospital (>500 beds)
Medium sized hospital (100-500 beds)
Small hospital (20-99 beds)
Very small hospital (<20 beds)
Not applicable- I don’t see patients at any other
hospital
I don’t know
Did not answer
B. Hospital Facilities 1. What is the infrastructure available at each of the hospitals (up to 5 hospitals)
where you see stroke patients?
HOSPITAL 1
HOSPITAL 2
HOSPITAL 3
HOSPITAL 4
HOSPITAL 5
I DO NOT see patients at
Appendix 1
this hospitalEmergency RoomStroke ICUStroke UnitHospital general in-patient wardOut-patient clinicIn-patient rehabilitation unitOut-patient rehabilitation servicesTelemedicine
2. What are the diagnostic capabilities available at each of the hospitals you see stroke patients at?
HOSPITAL 1 HOSPITAL 2 HOSPITAL 3 HOSPITAL 4 HOSPITAL 5
I DO NOT see patients at this hospitalHematology LaboratoryMicrobiology LaboratoryChest X-RayOxygen Saturation MonitoringHead CT scanBrain CT perfusionCerebral CT angiogramMRI BrainBrain MR Perfusion
Appendix 1
Brain MR angiogramDiagnostic cerebral angiogramTransthoracic EchocardiogramTransesophageal EchocardiogramExtracranial Doppler UltrasoundTranscranial Doppler UltrasoundElectrocardiogramCardiac telemetry
3. What are the types of personnel available at each of the hospitals you see stroke patients at?
HOSPITAL 1 HOSPITAL 2 HOSPITAL 3 HOSPITAL 4 HOSPITAL 5
I DO NOT see patients at this hospitalStroke SpecialistIntensive Care SpecialistCardiologistNeurosurgeonNeuroradiologistInterventional NeuroradiologistPhysical and/or Occupational
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TherapistSpeech TherapistDieticianPharmacist
4. What are the treatments offered at the hospitals where you see stroke patients?
HOSPITAL 1 HOSPITAL 2 HOSPITAL 3 HOSPITAL 4 HOSPITAL 5
I DO NOT see patients at this hospitalOxygen supplementationIntravenous fluidsEnteral tube feedingMechanical lower extremity compression devices to prevent lower extremity deep venous thrombosisProphylactic anticoagulation to prevent deep venous thrombosisIntravenous thrombolysisIntra-arterial thrombolysis (chemical or mechanical)Hemicraniectomy
Appendix 1
for strokeCarotid endarterectomyIntracranial or extracranial cerebrovascular stentingPhysical and/or occupational therapyStroke Education
5. Do you have a written protocol for the management of stroke patients at the hospitals you see patients at?
HOSPITAL 1 HOSPITAL 2 HOSPITAL 3 HOSPITAL 4 HOSPITAL 5
I DO NOT see patients at this hospitalTransient Ischemic AttackAcute Ischemic StrokeIntracerebral Hemorrhage
C. Coding1. At the current time, how are medical records stored at each of the hospitals
you see stroke patients at?
HOSPITAL 1 HOSPITAL 2 HOSPITAL 3 HOSPITAL 4 HOSPITAL 5
I DO NOT see patients at this hospitalRecords not stored
Appendix 1
Electronic record StoragePartly electronic and partly paper record storageOnly paper record storageI don’t know
III. STROKE DIAGNOSIS AND TREATMENTA. Stroke Diagnosis
1. What percentage of your stroke patients have access to AND can afford the following diagnostic modalities?
ALL MY PATIENTS
MOST (>50%) BUT NOT ALL MY
PATIENTS
SOME (<50%) OF MY
PATIENTS
NONE OF MY PATIENTS
I DON’T KNOW
Complete blood count (Hemoglobin, white blood cell count and platelet count)Blood Urea Nitrogen and creatinineSerum electrolytesProthrombin time and partial thromboplastin timeSerum lipid profileCerebrospinal fluid analysis (cell count, protein, glucose, gram
Appendix 1
stain and bacterial culture)Chest X-RayHead CT scanBrain CT perfusionCerebral CT angiogramMRI BrainBrain MR PerfusionBrain MR angiogramDiagnostic cerebral angiogramTransthoracic EchocardiogramTransesophegeal EchocardiogramExtracranial Doppler UltrasoundTranscranial Doppler UltrasoundElectrocardiogramCardiac telemetry
B. In-hospital treatment1. What percentages of your stroke patients have access to AND can afford the
following specific and supportive stroke treatments?
ALL MY PATIENTS
MOST (>50%) BUT NOT ALL MY
PATIENTS
SOME (<50%) OF MY
PATIENTS
NONE OF MY PATIENTS
I DON’T KNOW
Oxygen supplementation
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Intravenous fluidsEnteral tube feedingMechanical lower extremity compression devices to prevent lower extremity deep venous thrombosisProphylactic anticoagulation to prevent deep venous thrombosisIntravenous thrombolysisIntra-arterial thrombolysis (chemical or mechanical)Hemicraniectomy for strokeCarotid endarterectomyIntracranial or extracranial cerebrovascular stentingPhysical and/or occupational therapyStroke Education
C. Secondary Stroke Prevention
Appendix 1
1. What percentages of your stroke patients have access to AND can afford the following antiplatelet agents?
ALL MY PATIENTS
MOST (>50%) BUT NOT ALL MY
PATIENTS
SOME (<50%) OF MY
PATIENTS
NONE OF MY PATIENTS
I DON’T KNOW
AspirinAspirin + Delayed Release DipyridamoleClopidogrelTiclopidinePrasurgelCilostazolTicagrelor
2. What percentages of your stroke patients have access to AND can afford the following anticoagulants agents?
ALL MY PATIENTS
MOST (>50%) BUT NOT ALL MY
PATIENTS
SOME (<50%) OF MY
PATIENTS
NONE OF MY PATIENTS
I DON’T KNOW
Intravenous Heparin InfusionLow Molecular Weight Heparin Oral Vitamin K Antagonists (such as warfarin)Oral direct thrombin inhibitors (such as Digabatran)Direct factor Xa inhibitors (such as Rivaroxaban)
3. What percentages of your stroke patients have access to AND can afford the following antihypertensive agents?
ALL MY PATIENTS
MOST (>50%) BUT NOT ALL MY
PATIENTS
SOME (<50%) OF MY
PATIENTS
NONE OF MY PATIENTS
I DON’T KNOW
Appendix 1
DiureticsPeripheral adrenergic receptor antagonists (such as beta blockers)Central alpha agonists (such as clonidine or methyl dopa)Calcium channel blockersAngiotensin converting enzyme inhibitorsAngiotensin receptor blockersVasodilators
4. What percentages of your stroke patients have access to AND can afford the following lipid lowering agents?
ALL MY PATIENTS
MOST (>50%) BUT NOT ALL MY
PATIENTS
SOME (<50%) OF MY
PATIENTS
NONE OF MY PATIENTS
I DON’T KNOW
HMG CoA reductase inhibitors (statin drugs)Bile acid sequestrants (e.g cholestyramine)Niacin (Nicotinic acid)Other lipid lowering agents (e.g gemfibrozil, clofibrate, etc)
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5. What percentages of your stroke patients have access to AND can afford the following blood glucose lowering agents?
ALL MY PATIENTS
MOST (>50%) BUT NOT ALL MY
PATIENTS
SOME (<50%) OF MY
PATIENTS
NONE OF MY PATIENTS
I DON’T KNOW
Oral hypoglycemicsInsulin
IV. QUALITY INDICATORSWhat percentages of your stroke patients meet the following quality indicators?
ALL MY PATIENTS
MOST (>50%) BUT NOT ALL MY
PATIENTS
SOME (<50%) OF MY
PATIENTS
NONE OF MY PATIENTS
I DON’T KNOW
Venous thromboembolism prophylaxis during hospital stayDischarged on antithrombotic therapyAnticoagulation for atrial fibrillation/flutterConsidered for acute thrombolytic therapyAntithrombotic therapy by end of hospital day 2Discharged on statin medicationStroke educationAssessed for rehabilitation
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V. CONTACT INFORMATION (OPTIONAL)Name
Company
Address
City/Town
State/Province
Zip/Postal Code
Country
Email Address
Phone Number