AUTHOR=Gupta Shweta , Bhatia Rohit , Srivastava Madakasira Vasantha Padma , Haldar Partha , Singh Mamta Bhushan , Salunkhe Manish , Longkumer Imnameren , Prasad Deepshikha , Sarkar Risha , Sardana Vijay , Maheshwari Dilip , Bhushan Bharat , Verma Alok , Dongre Nikhil , Sahu Nikhil , Panda Samhita , Anand Sucharita , Ray Biman Kanti , Puri Inder , Zanzmera Paresh , Gamit Amit , Bhoi Sanjeev Kumar , Jha Menka , Samal Priyanka , Gopi Seepana , Raju Garuda Butchi , Bhardwaj Amit , Sibia Raminder Singh , Kaur Rupinderjeet , Tiwari Ashutosh , Kumar Niraj , Singh Mritunjai , Bala Kiran , Dabla Surekha , Chawla Mahindar Pal Singh , Garg Jyoti , Chandan Shishir , Malik Rupali , Iype Thomas , Pushpa Chithra , Kumar Ashok , Ranjan Abhay , Garg Ravinder , Sulena Sulena , Darole Pramod , Chhina Gurpreet , Shah Shalin , Shah Sudhir , Ranga Gajendra , Nath Smita , Saluja Alvee , Ghotekar Lekhraj Hemraj , Vishnu Venugopalan Y. , Rajan Roopa , Gupta Anu , Vibha Deepti , Singh Rajesh Kumar , Pandit Awadh Kishor , Agarwal Ayush , Rohila Amit , Khera Pushpinder , Tiwari Sarbesh , Bhaskar Suryanarayanan , Garg Mayank , Dey Anupam , Guru Satyabrata , Naik Suprava , Kumar T. Sateesh , Dhar Minakshi , Agrawal Naman , Patel Mayank , Joshi Pranav 

TITLE=Assessment of acute stroke care, stroke metrics and patient outcomes: analysis from the pre-implementation phase of the IMPETUS stroke study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1697658

DOI=10.3389/fneur.2025.1697658

ISSN=1664-2295

ABSTRACT=BackgroundStroke is a major cause of death and disability in India. Many stroke patients seek care at government medical colleges but studies have not comprehensively assessed the quality of acute stroke care. This study aims to evaluate key indicators for optimal stroke care in the pre- implementation phase of implementation of an evaluation and treatment package for uniform stroke care (IMPETUS) study across 23 medical colleges in India.MethodsIMPETUS stroke is a multicentric, prospective, multiphase, mixed-methods, quasi-experimental implementation study, comprising three phases. During its pre-implementation phase, baseline assessment of stroke care was performed using pre-structured case report form, among prospectively enrolled acute stroke patients.ResultsA total of 2,018 patients were enrolled during the pre-implementation phase. The mean (SD) age was 59.08 (14.4) years, with male preponderance (64.2%); 69.06% had an onset <24 h, majority had ischemic stroke (60.1%), followed by intracerebral hemorrhage (38.4%). Key risk factors were hypertension, diabetes, smoking, alcohol and previous stroke. Imaging performed included non-contrast computed tomography (NCCT) (69.6%), computed tomography angiography (CTA) (25.6%) and magnetic resonance angiography (MRA) (24.6%). Intravenous thrombolysis (IVT) was administered in 39.2% eligible patients, predominantly with tissue plasminogen activator (tPA) (72%). In-hospital delay was the most common reason for not receiving thrombolysis (44.8%). The median door-to-CT, CT-to-needle and door-to-needle time were 95, 36.5 and 67 min, respectively. Other important stroke care indices were also evaluated. In-hospital mortality was 19.4 and 33.1% patients achieved modified rankin scale (mRS) score 0–2 at 90-days.ConclusionThis comprehensive data provides a representative baseline status of acute stroke care in select medical colleges across India, which will be useful in comparing advancements during the implementation phase and improve policy making.