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

Appendix 1

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

Appendix 1

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)

Appendix 1

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

Appendix 1

V. CONTACT INFORMATION (OPTIONAL)Name      

Company      

Address      

City/Town      

State/Province      

Zip/Postal Code      

Country      

Email Address      

Phone Number