OBJECTIVES:

The cost-effectiveness of clinical interventions is often assessed using current care as a comparator. However, various imaging options are available in current stroke care and evidence suggests clinical practice variation in acute stroke imaging across European countries. This research aims to describe the patterns of stroke imaging, examine variations across four selected countries and obtain results that will be used in future cost-effectiveness analyses of imaging strategies.

METHODS:

A systematic literature review was conducted. Embase, Medline, Web of Science, the Cochrane Library and Google Scholar were researched in August 2016. The search strategy focused on the current imaging workup used in acute stroke care in clinical practice in Hungary, Germany, Sweden and the UK. Characteristics extracted from these studies included the type and number of health centres and patients, the study design and goal and information about the data found. Information regarding the type and frequency of imaging techniques used was extracted and analysed.

RESULTS:

The literature search yielded 3616 records. Sixteen eligible studies were identified for final analysis. The complete imaging methods used to diagnose stroke patients were poorly documented. Computed Tomography (CT) appeared to be the main diagnostic imaging used in stroke care (for 78 to 98% of patient profiles across the 3 countries over different periods). Magnetic Resonance Imaging (MRI) was reported to be substantially less used. Studies performed in the UK revealed dramatic variations in the proportion of scanned patients and timing of imaging.

CONCLUSIONS:

The imaging strategy documentation, the proportion of patients scanned and the timing of imaging is insufficiently described in the literature. The heterogeneity in stroke imaging observed in this study reinforces the need to compare the quality of care in terms of process and outcomes within and between countries. Research is also needed to investigate the cost-effectiveness of different imaging strategies.