Prehospital Video Triage for stroke: evaluation of the PVT service

Introduction: Prehospital vide triage offers the potential to improve prehospital decision-making before hospital arrival. This study aimed to evaluate the newly introduced Prehospital Video Triage (PVT) service for suspected stroke patients at Northampton General Hospital, University Hospitals of Northamptonshire NHS Trust.

Method: A retrospective comparative analysis was conducted of two cohorts: patients triaged via the standard non-PVT pathway (n = 229) and patients assessed via the PVT service (n = 308), covering the period January to May 2026. Both groups included only calls originating from the East Midlands Ambulance Service (EMAS), assessed by the stroke nurse on duty. 

Results: Acceptance rates were comparable between groups (non-PVT 36.2% vs PVT 40.9%; p = 0.314). Among accepted patients, the proportion with confirmed stroke was significantly higher in the PVT group (75.4% vs 61.4%; p = 0.046). The non-stroke rate was in the PVT group was 20.6% vs 27.7% in non-PVT; p=0.310. No patient declined by PVT was subsequently confirmed as a stroke, compared with one false negative in the non-PVT group. Reperfusion therapy was administered in 17.5% of PVT and 22.9% non-PVT groups; p = 0.626). PVT was associated with earlier CT request (median −12 min vs +4 min; p = 0.030). Among patients receiving thrombolysis (n = 32; PVT 18, non-PVT 14), door-to-needle time was similar between groups (median 48 vs 44 min; p = 0.820). In the mechanical thrombectomy transfer subgroup (n = 12; PVT 6, non-PVT 6), door-to-referral time (38 vs 64 min) was numerically shorter in PVT patients, but did not reach statistical significance.

Conclusions: The PVT service was associated with greater diagnostic precision, with a higher proportion of confirmed strokes among accepted patients and no missed strokes in the declined group. PVT by a specialist stroke nurse is an effective and safe model for prehospital stroke assessment.