107. Impact of Penicillin Allergy Assessment During Pre-Anesthesia Testing (PAT) on Beta-Lactam Surgical Prophylaxis in Bariatric Surgery Patients

Abstract Background Due to utilization of alternative antibiotics, documented penicillin (PCN) allergies are associated with an increased risk of surgical site infections, cost, and infections caused by resistant organisms. In October 2019, a community hospital implemented a beta-lactam (BL) allergy assessment service in a pre-anesthesia testing (PAT) clinic without access to allergy specialists or PCN skin testing (PST). In phase 1, the surgeon was contacted to change surgical prophylaxis for BL eligible patients based on the assessment. In phase 2, an automatic protocol was implemented to allow advanced practice providers (APPs) to switch from alternative antibiotics in BL eligible patients. The objective of this study was to assess the impact of the PCN assessment service and protocol on BL surgical prophylaxis. Methods This retrospective cohort study included bariatric surgery patients who visited PAT clinic with a documented BL allergy between Jun 2019-Sept 2019 (control), Nov 2019-Feb 2020 (phase 1), and Nov 2020-Feb 2021 (phase 2). Patients with procedures not requiring surgical prophylaxis were excluded. Patients were determined to be eligible for BL surgical prophylaxis if: intolerance or mild-moderate reaction to PCN, previously tolerated cephalosporin, intolerance to cephalosporin, or surgeon deemed it appropriate. The primary outcome was overall utilization of BL surgical prophylaxis. Results This study included 38 patients in the control group, 14 in the phase 1 group, and 17 in the phase 2 group. Overall utilization of BL surgical prophylaxis significantly increased with 16% in the control group, 43% in the phase 1 group, and 65% in the phase 2 group (p=0.001). In the BL eligible patient subgroup, BL surgical prophylaxis significantly increased with 35% (n=6/17) in the control group, 50% (n=6/12) in the phase 1 group, and 92% (n=11/12) in the phase 2 group (p= 0.001). There were no reported surgical site infections or adverse drug reactions. Conclusion Overall utilization of BL surgical prophylaxis significantly increased after implementation of a PCN allergy assessment service with an automatic protocol for patients determined as BL eligible. This service and protocol demonstrates successful optimization of surgical prophylaxis when allergy specialists or PST is not available. Disclosures All Authors: No reported disclosures

Download Full-text

137. Impact of Antimicrobial Stewardship Interventions on Post-Elective Caesarean Antibiotic Prophylaxis and Surgical Site Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.339 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S182-S182

Author(s):

Xue Fen Valerie Seah ◽

Yue Ling Rina Ong ◽

Wei Ming Cedric Poh ◽

Shahul Hameed Mohamed Siraj ◽

Kai-Qian Kam ◽

...

Keyword(s):

Risk Factors ◽

Antibiotic Prophylaxis ◽

Patient Outcomes ◽

Phase 1 ◽

Surgical Site Infections ◽

Phase 2 ◽

Oral Antibiotics ◽

Post Intervention ◽

Phase 3 ◽

The Impact

Abstract Background Antimicrobial stewardship programs (ASP) aim to improve appropriate antimicrobial use. Post-operative antibiotics are generally not necessary, especially those without surgical site infections risk factors (e.g. obesity). Few studies have described the impact of ASP interventions on patient outcomes especially in unique populations such as obstetrics. This study aims to evaluate the impact of ASP interventions on post-elective caesarean (eLSCS) oral antibiotic prophylaxis use and patient outcomes including SSI rates. Methods This pre-post quasi-experimental study was conducted over 9 months (2 months pre- and 7 months post-intervention) in all women admitted for eLSCS in our institution. Interventions included eLSCS surgical prophylaxis guideline dissemination, where a single antibiotic dose within 60 minutes before skin incision was recommended. Post-eLSCS oral antibiotics was actively discouraged in those without SSI risk factors. This was followed by ASP intervention notes (phase 1) for 3 months, and an additional phone call to the ward team for the next 7 months (phase 2). Phase 3 (next 6 months) constituted speaking to the operating consultant. The primary outcome was post-operative oral antibiotics prescription rates. Secondary outcomes included rates of 30-day post-operative SSI. Results A total of 1751 women was reviewed. Appropriateness of pre-operative antibiotic prophylaxis was 98% in our institution. There were 244 women pre-intervention, 274 in post-intervention phase 1, 658 in phase 2 and 575 in phase 3. Pre-intervention post-eLSCS antibiotic prescribing rates was 82% (200), which reduced significantly post-intervention to 54% (148) in phase 1, 50% (331) in phase 2 and 39% (226) in phase 3 (p< 0.001). There was no significant difference in patients who developed post-operative SSI pre-post intervention (0.8%, 2 of 242 vs. 1.9%, 28 of 1479, p=0.420) and among who received post-operative oral antibiotics compared to those without (1.9%, 17 of 905 vs. 1.5%, 13 of 846, p=0.582). Conclusion ASP interventions can reduce post-eLSCS antibiotic prophylaxis rates without adversely impacting patient safety. Disclosures All Authors: No reported disclosures

Download Full-text

Increased Risk of Complications After Pancreatoduodenectomy in Uninephrectomized Patients

International Surgery ◽

10.9738/intsurg-d-18-00022.1 ◽

2018 ◽

Vol 103 (7-8) ◽

pp. 386-395

Author(s):

Tadataka Takagi ◽

Masayuki Sho ◽

Satoshi Nishiwada ◽

Takahiro Akahori ◽

Minako Nagai ◽

...

Keyword(s):

Acute Kidney Injury ◽

Postoperative Complications ◽

Kidney Injury ◽

Surgical Site Infections ◽

Morbidity Rate ◽

Control Group ◽

Study Objective ◽

Soft Pancreas ◽

Increased Risk ◽

The Impact

Objective: The study objective is to investigate the impact of unilateral nephrectomy on the complications after pancreatoduodenectomy (PD). Summary of background data: Preoperative renal insufficiency is a risk factor for postoperative complications and mortality after various types of surgery. However, the specific postoperative risks in uninephrectomized (UN) patients are largely unknown. Methods: Between January 2010 and June 2014, a total of 177 patients underwent PD at the Department of Surgery, Nara Medical University. Among them, 7 patients (4.0%) were UN. We retrospectively evaluated the influence of the UN status on the postoperative complications. Results: The rate of acute kidney injury in the UN group was significantly higher than that in the control group (28.6% versus 1.2%; P = 0.017). In addition, the rates of surgical site infection of the organ/space (57.1% versus 9.0%; P = 0.006) and sepsis (42.9% versus 3.5%; P = 0.003) in UN group were significantly higher. Even on a reanalysis of only patients with soft pancreas, the significance remained. Conclusions: The UN status has a significant impact on the rate of morbidities, such as acute kidney injury and various infectious complications, including surgical site infections of organ/space, sepsis, and cholangitis after PD. Appropriate intervention should be implemented to decrease the morbidity rate for UN patients.

Download Full-text

A PRACT: A Pragmatic Randomized Adaptive Clinical Trial to Investigate Brief Interventions in the Emergency Department in Tanzania

10.31234/osf.io/qz3kh ◽

2018 ◽

Author(s):

Joao Ricardo Nickenig Vissoci

Keyword(s):

Emergency Department ◽

Alcohol Use ◽

Low Income ◽

Controlled Trial ◽

Phase 1 ◽

Fine Tuning ◽

Acute Injury ◽

Control Group ◽

Phase 2 ◽

The Impact

BackgroundAlcohol abuse, especially in resource limited low income settings, comes with increased health and injury risks. Treatment in these settings lacks the specialized trained personnel and infrastructure. Implementing evidence based interventions from a high-income setting, like a Brief Intervention (BI) for alcohol administered to Emergency Department injury patients, will require fine tuning and adaptations to the setting, population and culture. As such, this study aims to rapidly optimize and evaluate the impact of a BI to control alcohol use and related harms. Methods/DesignOur single-blinded adaptive randomized controlled trial is designed to determine the most efficacious BI intervention to reduce hazardous alcohol use among acute injury patients. Phase 1, in this ‘seamless phase 1 to phase 2’ adaptive trial, will determine if a BI with or without a SMS booster is more effective than a no-contact usual care. Without a change in study procedures and statistical efficiency, phase 2 will compare if a BI without or with a standard SMS booster is more effective. Finally, in Phase 3, we will compare the more effective arm in Phase 2 to a new BI with personalized SMS booster. The study will occur among acute injury patients who present to Kilimanjaro Christian Medical Center referral hospital in Northern Tanzania who are 1) alcohol positive on arrival to the hospital, 2) have an Alcohol Use Disorder Identification Test of 8 or above or 3) have admitted to drinking alcohol prior to suffering their injury. The intervention consists of a nurse administered brief motivational interviewing session with or without a standard or personalized SMS booster; the control group will be a no-contact group until the time of follow-up. The primary outcome for the study is mean weekly consumption and number of binge drinking events; the secondary outcomes for the study are a reduction of alcohol related consequences by the Drinker Inventory of Consequences.

Download Full-text

Differential impact of on-site or telepharmacy in the intensive care unit: a controlled before–after study

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab011 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Joao Gabriel Rosa Ramos ◽

Sandra Cristina Hernandes ◽

Talita Teles Teixeira Pereira ◽

Shana Oliveira ◽

Denis de Melo Soares ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Phase 1 ◽

Phase 2 ◽

Differential Impact ◽

Scarce Resources ◽

Clinical Pharmacists ◽

Versus Phase ◽

Quasi Experimental ◽

The Impact

Abstract Background Clinical pharmacists have an important role in the intensive care unit (ICU) team but are scarce resources. Our aim was to evaluate the impact of on-site pharmacists on medical prescriptions in the ICU. Methods This is a retrospective, quasi-experimental, controlled before-after study in two ICUs. Interventions by pharmacists were evaluated in phase 1 (February to November 2016) and phase 2 (February to May 2017) in ICU A (intervention) and ICU B (control). In phase 1, both ICUs had a telepharmacy service in which medical prescriptions were evaluated and interventions were made remotely. In phase 2, an on-site pharmacist was implemented in ICU A, but not in ICU B. We compared the number of interventions that were accepted in phase 1 versus phase 2. Results During the study period, 8797/9603 (91.6%) prescriptions were evaluated, and 935 (10.6%) needed intervention. In phase 2, there was an increase in the proportion of interventions that were accepted by the physician in comparison to phase 1 (93.9% versus 76.8%, P < 0.001) in ICU A, but there was no change in ICU B (75.2% versus 73.9%, P = 0.845). Conclusion An on-site pharmacist in the ICU was associated with an increase in the proportion of interventions that were accepted by physicians.

Download Full-text

Neurodevelopment in Children Exposed to Zika Virus: What Are the Consequences for Children Who Do Not Present with Microcephaly at Birth?

Viruses ◽

10.3390/v13081427 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1427

Author(s):

Paula Sobral da Silva ◽

Sophie Eickmann ◽

Ricardo Ximenes ◽

Celina Martelli ◽

Elizabeth Brickley ◽

...

Keyword(s):

Neurological Examination ◽

Zika Virus ◽

Control Group ◽

P Value ◽

Zikv Infection ◽

Clinical Neurological Examination ◽

Cognitive Delay ◽

Increased Risk ◽

Neurodevelopmental Impairment ◽

The Impact

The relation of Zika virus (ZIKV) with microcephaly is well established. However, knowledge is lacking on later developmental outcomes in children with evidence of maternal ZIKV infection during pregnancy born without microcephaly. The objective of this analysis is to investigate the impact of prenatal exposure to ZIKV on neuropsychomotor development in children without microcephaly. We evaluated 274 children including 235 ZIKV exposed and 39 controls using the Bayley-III Scales of Infant and Toddler Development (BSIDIII) and neurological examination. We observed a difference in cognition with a borderline p-value (p = 0.052): 9.4% of exposed children and none of the unexposed control group had mild to moderate delays. The prevalence of delays in the language and motor domains did not differ significantly between ZIKV-exposed and unexposed children (language: 12.3% versus 12.8%; motor: 4.7% versus 2.6%). Notably, neurological examination results were predictive of neurodevelopmental delays in the BSIDIII assessments for exposed children: 46.7% of children with abnormalities on clinical neurological examination presented with delay in contrast to 17.8% among exposed children without apparent neurological abnormalities (p = 0.001). Overall, our findings suggest that relative to their unexposed peers, ZIKV-exposed children without microcephaly are not at considerably increased risk of neurodevelopmental impairment in the first 42 months of life, although a small group of children demonstrated higher frequencies of cognitive delay. It is important to highlight that in the group of exposed children, an abnormal neuroclinical examination may be a predictor of developmental delay. The article contributes to practical guidance and advances our knowledge about congenital Zika.

Download Full-text

Impact of the COVID-19 Pandemic on the Patient’s Decision about Bariatric Surgery: Results of a National Survey

Medicina ◽

10.3390/medicina57080756 ◽

2021 ◽

Vol 57 (8) ◽

pp. 756

Author(s):

Maciej Walędziak ◽

Anna Różańska-Walędziak ◽

Paweł Bartnik ◽

Joanna Kacperczyk-Bartnik ◽

Andrzej Kwiatkowski ◽

...

Keyword(s):

Bariatric Surgery ◽

Online Survey ◽

Negative Impact ◽

Weight Loss Surgery ◽

General Information ◽

Open Questions ◽

Increased Risk ◽

Bariatric Patients ◽

The Moment ◽

The Impact

Background: the COVID-19 pandemic and the implemented restrictions have changed the functioning of healthcare systems worldwide. The purpose of the study was to evaluate the impact of the present epidemiological situation on patients’ decisions about undergoing weight loss surgery. Methods: data were collected from 906 bariatric patients by the means of a national online survey, the majority of whom were women (87.9%). The survey started on 9 April 2020 and was open until 28 April 2020. The questionnaire included multiple choice and open questions, divided into three chapters: general information about the patient, life during the COVID-19 pandemic, and bariatric care during the COVID-19 pandemic. Results: despite the pandemic and the associated risk of COVID-19 infection, 443 responders (48.9%) would have decided to undergo bariatric surgery. Awareness of the negative impact of obesity on the course of COVID-19 illness had only marginable impact on patients’ decision-making (76.6% vs. 75.3%; p < 0.80). Contact with COVID-19 prior to the survey had a negative impact on the willingness to undergo bariatric surgery (3.0% vs. 4.4%; p < 0.55). There was a positive correlation between the BMI and preference for bariatric surgery in the time of the pandemic (37.4 ± 9.0 vs. 34.9 ± 8.7; p < 0.001). Conclusions: the level of awareness about the advantages of operative treatment of obesity is high among bariatric patients. The majority of patients awaiting bariatric surgery at the moment of the survey were positive about undergoing bariatric surgery despite the increased risk of a serious course of COVID-19 infection. Therefore, a large proportion of patients was determined to have bariatric treatment even during the pandemic, being aware of the increased risk of worse pace of COVID-19 disease in case of obesity and related diseases.

Download Full-text

The Use of Vancomycin Powder for Surgical Prophylaxis Following Craniotomy

Neurosurgery ◽

10.1093/neuros/nyw127 ◽

2017 ◽

Vol 80 (5) ◽

pp. 754-758 ◽

Cited By ~ 17

Author(s):

Vinod Ravikumar ◽

Allen L. Ho ◽

Arjun V. Pendharkar ◽

Eric S. Sussman ◽

Kevin Kwong-hon Chow ◽

...

Keyword(s):

Ad Hoc ◽

Cost Savings ◽

Surgical Site Infections ◽

Control Group ◽

Infection Prophylaxis ◽

Potential Cost Saving ◽

Infection Rates ◽

Surgical Prophylaxis ◽

Potential Cost ◽

Vancomycin Powder

Abstract BACKGROUND: Intrawound vancomycin powder has been studied extensively in spinal fusion surgeries and been found to reduce rates of surgical site infections (SSIs) significantly. Despite its success in spinal surgeries, topical vancomycin has not been extensively studied with respect to cranial neurosurgery. OBJECTIVE: To evaluate the efficacy of intrawound topical vancomycin for prevention of SSIs following open craniotomies. METHODS: We retrospectively analyzed a large series of 350 patients from 2011 to 2015 in a pre/postintervention study of use of topical vancomycin to reduce postoperative craniotomy infection rates. We had a preintervention control group of 225 patients and a postintervention group of 125 patients that received intrawound topical vancomycin. RESULTS: Our preintervention incidence of SSI was 2.2% and this was significantly reduced to 0% following introduction of topical vancomycin (P < .5). An ad hoc cost analysis suggested a cost savings of ${\$}$59 965 with the use of topical vancomycin for craniotomies. CONCLUSION: Our study found a significant reduction in SSI rates after introduction of topical vancomycin. Thus, this simple intervention should be considered in all open craniotomy patients as both infection prophylaxis and a potential cost saving intervention.

Download Full-text

Shingles Immunity and Health Functioning in the Elderly:Tai Chi Chihas a Behavioral Treatment

Evidence-based Complementary and Alternative Medicine ◽

10.1093/ecam/neh048 ◽

2004 ◽

Vol 1 (3) ◽

pp. 223-232 ◽

Cited By ~ 30

Author(s):

Michael Irwin ◽

Jennifer Pike ◽

Michael Oxman

Keyword(s):

Older Adults ◽

Behavioral Treatment ◽

Tai Chi ◽

Relaxation Response ◽

Control Group ◽

Varicella Zoster ◽

Specific Immunity ◽

Health Functioning ◽

Increased Risk ◽

The Impact

Both the incidence and severity of herpes zoster (HZ) or shingles increase markedly with increasing age in association with a decline in varicella zoster virus (VZV)-specific immunity. Considerable evidence shows that behavioral stressors, prevalent in older adults, correlate with impairments of cellular immunity. Moreover, the presence of depressive symptoms in older adults is associated with declines in VZV-responder cell frequency (VZV-RCF), an immunological marker of shingles risk. In this review, we discuss recent findings that administration of a relaxation response-based intervention,tai chi chih(TCC), results in improvements in health functioning and immunity to VZV in older adults as compared with a control group. TCC is a slow moving meditation consisting of 20 separate standardized movements which can be readily used in elderly and medically compromised individuals. TCC offers standardized training and practice schedules, lending an important advantage over prior relaxation response-based therapies. Focus on older adults at increased risk for HZ and assay of VZV-specific immunity have implications for understanding the impact of behavioral factors and a behavioral intervention on a clinically relevant end-point and on the response of the immune system to infectious pathogens.

Download Full-text

MOLECULAR GENETIC STUDY OF THE IMPACT OF SNP C677T OF THE GENE MTHFR IN THE DEVELOPMENT OF CONGENITAL ISOLATED CLEFT LIP AND PALATE

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2018-25-5-104-110 ◽

2018 ◽

Vol 25 (5) ◽

pp. 104-110

Author(s):

V. S. Uchaeva ◽

Yu. A. Vasiliev ◽

A. S. Gracheva ◽

O. V. Gulenko ◽

I. G. Udina

Keyword(s):

Genetic Study ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Control Group ◽

Population Genetic Study ◽

Molecular Genetic Study ◽

Increased Risk ◽

Significant Difference ◽

Congenital Cleft ◽

The Impact

Aim. This research was designed to conduct an associative population genetic study for the consideration of the impact of SNP C677T of the gene MTHFR in the congenital maxillofacial developmental anomalies (CMDA): congenital cleft lip (CCL), congenital cleft palate (CCP), congenital cleft lip and palate (CCLP) in the Krasnodar territory. The aim of the study is to establish the associations between SNP C677T of the gene MTHFR and the development of congenital cleft lip and/ or palate.Materials and methods. In this research, the peculiarities of distribution of SNP C667T of the gene MTHFR in children with congenital cleft lip and/or palate (n=223) and their mothers (n=78) in comparison with the control group (n=124) were studied in the Krasnodar territory. The genetic demographic questionnaires were gathered for children with CMDA, the information about diagnosis was obtained from the medical records. The biological samples, including blood or scrapings of oral mucosa, were collected from children with the pathology and their mothers. The DNA was extracted from the samples by the standard method. The study of the peculiarities of distribution of alleles of SNP C677T of the gene MTHFR was performed by PCR-PFLP with endonuclease Hinf I or by tetra-primer ARMS-PCR method in children with CCL, CCP, CCLP, their mothers and the control group. Statistical processing of the obtained data was performed by the algorithms of the “Statistica” program.Results. While comparing the profiles of frequencies of SNP C677T in children with CCL, CCP and CCLP with the control group, there were identified no significant differences in the frequency of this SNP and no peculiarities of genotypes distribution. There was identified a significant difference in the peculiarities of genotypes distribution with the control group (G=19,5232, d.f.=1, p<0,001) as well as united genotypes (С/C и С/T) in accordance to T/T (G=10,4657, d.f.=1; p<0,001) and united genotypes (C/T и T/T) in accordance to C/C (G=15,1896, d.f.=1, p<0,001) for the mothers of children with CCL, CCP and CCLP.Conclusion. As a result of the study, we established the association of SNP C677T of the MTHFR gene with the development of congenital cleft lip and/or palate: mothers’ T/T genotype is associated with the increased risk of giving birth to a child with CCL, CCP and CCLP (in comparison with mothers with C/C+C/T genotype): odds ratio [OR]=16,63, 95% CI: 3,86-71,71; p=0,0003 and also for mothers with genotypes (C/T+T/T) in comparison with mothers with genotypes C/C: OR=3,22, CI:1,71-6,08; p=0,0002. The amount of risk is not significant in children with CMDA for T/T genotype. So it is possible to make a conclusion about the impact of C677T of the gene MTHFR in the development of CCL, CCP and CCLP only in mother’s genotype.

Download Full-text

Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) – a programme of research to facilitate recognition of stroke by emergency medical dispatchers

Programme Grants for Applied Research ◽

10.3310/pgfar02010 ◽

2014 ◽

Vol 2 (1) ◽

pp. 1-124 ◽

Cited By ~ 1

Author(s):

Caroline L Watkins ◽

Stephanie P Jones ◽

Michael J Leathley ◽

Gary A Ford ◽

Tom Quinn ◽

...

Keyword(s):

Phase 1 ◽

Research Programme ◽

Online Training ◽

Final Diagnosis ◽

Phase 2 ◽

The Public ◽

Training Package ◽

Emergency Medical ◽

Emergency Medical Dispatchers ◽

The Impact

BackgroundRapid access to emergency stroke care can reduce death and disability by enabling immediate provision of interventions such as thrombolysis, physiological monitoring and stabilisation. One of the ways that access to services can be facilitated is through emergency medical service (EMS) dispatchers. The sensitivity of EMS dispatchers for identifying stroke is < 50%. Studies have shown that activation of the EMSs is the single most important factor in the rapid triage and treatment of acute stroke patients.ObjectivesTo facilitate recognition of stroke by emergency medical dispatchers (EMDs).DesignAn eight-phase mixed-methods study. Phase 1: a retrospective cohort study exploring stroke diagnosis. Phase 2: semi-structured interviews exploring public and EMS interactions. Phases 3 and 4: a content analysis of 999 calls exploring the interaction between the public and EMDs. Phases 5–7: development and implementation of stroke-specific online training (based on phases 1–4). Phase 8: an interrupted time series exploring the impact of the online training.SettingOne ambulance service and four hospitals.ParticipantsPatients arriving at hospital by ambulance with stroke suspected somewhere on the stroke pathway (phases 1 and 8). Patients arriving at hospital by ambulance with a final diagnosis of stroke (phase 2). Calls to the EMSs relating to phase 1 patients (phases 3 and 4). EMDs (phase 7).InterventionsStroke-specific online training package, designed to improve recognition of stroke for EMDs.Main outcome measuresPhase 1: symptoms indicative of a final and dispatch diagnosis of stroke. Phase 2: factors involved in the decision to call the EMSs when stroke is suspected. Phases 3 and 4: keywords used by the public when describing stroke and non-stroke symptoms to EMDs. Phase 8: proportion of patients with a final diagnosis of stroke correctly dispatched as stroke by EMDs.ResultsPhase 1: for patients with a final diagnosis of stroke, facial weakness and speech problems were significantly associated with an EMD code of stroke. Phase 2: four factors were identified – perceived seriousness; seeking and receiving lay or professional advice; caller’s description of symptoms and emotional response to symptoms. Phases 3 and 4: mention of ‘stroke’ or one or more Face Arm Speech Test (FAST) items is much more common in stroke compared with non-stroke calls. Consciousness level was often difficult for callers to determine and/or communicate. Phase 8: there was a significant difference (p = 0.003) in proportions correctly dispatched as stroke – before the training was implemented 58 out of 92 (63%); during implementation of training 42 out of 48 (88%); and after training implemented 47 out of 59 (80%).ConclusionsEMDs should be aware that callers are likely to describe loss of function (e.g. unable to grip) rather than symptoms (e.g. weakness) and that callers using the word ‘stroke’ or describing facial weakness, limb weakness or speech problems are likely to be calling about a stroke. Ambiguities and contradictions in dialogue about consciousness level arise during ambulance calls for suspected and confirmed stroke. The online training package improved recognition of stroke by EMDs. Recommendations for future research include testing the effectiveness of the Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) training package on the recognition of stroke across other EMSs in England; and exploring the impact of the early identification of stroke by call handlers on patient and process outcomes.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

Download Full-text