Accuracy of Emergency Medical Services–Reported Last Known Normal Times in Patients Suspected With Acute Stroke

Objective:To investigate the diagnostic yield of prehospital ECG monitoring provided by emergency medical services in the case of suspected stroke.Methods:Consecutive patients with acute stroke admitted to our tertiary stroke center via emergency medical services and with available prehospital ECG were prospectively included during a 12-month study period. We assessed prehospital ECG recordings and compared the results to regular 12-lead ECG on admission and after continuous ECG monitoring at the stroke unit.Results:Overall, 259 patients with prehospital ECG recording were included in the study (90.3% ischemic stroke, 9.7% intracerebral hemorrhage). Atrial fibrillation (AF) was detected in 25.1% of patients, second-degree or greater atrioventricular block in 5.4%, significant ST-segment elevation in 5.0%, and ventricular ectopy in 9.7%. In 18 patients, a diagnosis of new-onset AF with direct clinical consequences for the evaluation and secondary prevention of stroke was established by the prehospital recordings. In 2 patients, the AF episodes were limited to the prehospital period and were not detected by ECG on admission or during subsequent monitoring at the stroke unit. Of 126 patients (48.6%) with relevant abnormalities in the prehospital ECG, 16.7% received medical antiarrhythmic therapy during transport to the hospital, and 6.4% were transferred to a cardiology unit within the first 24 hours in the hospital.Conclusions:In a selected cohort of patients with stroke, the in-field recordings of the ECG detected a relevant rate of cardiac arrhythmia. The results can add to the in-hospital evaluation and should be considered in prehospital care of acute stroke.

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Abstract W P187: Utilization of Emergency Medical Services to Transfer Acute Stroke Patients Directly to Scanning Reduces the Length of Time to Scan Result

Stroke ◽

10.1161/str.45.suppl_1.wp187 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Scott Dunbar ◽

Theresa Hoffecker ◽

Avery Schwenk

Keyword(s):

Acute Stroke ◽

Ct Scan ◽

Emergency Medical Services ◽

Ct Scanning ◽

Medical Services ◽

Time Of Arrival ◽

Stroke Patients ◽

Emergency Medical ◽

Number Of Patients ◽

The Mean

Background: Rapid assessment and treatment of acute stroke patients including computerized tomography (CT) scanning to determine the need for tissue plasminogen activator (tPA) has been shown to be vital to positive patient outcomes. As part of an ongoing effort to reduce door-to-needle time for such patients, the door-to-CT result time was identified as an area that could be reduced by collaborative effort between Emergency Medical Services (EMS) and Emergency Department (ED) staff. We hypothesized that implementing an EMS protocol for direct-to-CT scanning as part of a collaborative stroke alert protocol would reduce overall door-to-CT result time. Methods: Local EMS and ED implemented criteria to alert the ED of acute stroke patients being transported to their facility. This alert included an estimated time of arrival and was sent to radiology, neurology, registration and pharmacy. Upon arrival, the patient was met by ED personnel while still on the EMS gurney. If the ED physician concurred with the field impression of acute stroke, the patient was taken directly to CT scanning by EMS. Data on time of door-to-CT result were collected from 7/9/12 to 7/8/13 and divided into those patients who received a stroke alert from EMS (n=41), and those who did not (n=81). All data are expressed as mean ± standard error. Results: The time for door-to-CT result was reduced (p<0.0001) for patients who received a stroke alert from EMS [16.5 ± 1.2 vs 31.6 ± 1.5 minutes, alert vs no alert, respectively]. Similarly, in the subset of patients who received tPA after the CT scan, the mean time door-to-CT scan results was reduced (p<0.005) in those patients who received a stroke alert from EMS (14.3 ± 1.1 vs 36.4 ± 7.3 minutes, alert vs no alert, respectively). Conclusions: Implementation of a stroke alert including a direct-to-CT protocol by EMS significantly reduced the mean door-to-CT result time in acute stroke patients. Expanding this protocol to include other area EMS services and hospitals could potentially result in a greater number of patients benefiting from these reduced times.

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Abstract TP250: A Substantial Rate of Neurological and Non-Neurological Stroke Mimics Are Transported by Emergency Medical Services for Acute Stroke Evaluation

Stroke ◽

10.1161/str.48.suppl_1.tp250 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Joel N Briard ◽

Rahel T Zewude ◽

Mahesh Kate ◽

Ken Butcher ◽

Laura C Gioia

Keyword(s):

Acute Stroke ◽

Emergency Medical Services ◽

Final Diagnosis ◽

Medical Services ◽

Cross Sectional ◽

Stroke Mimics ◽

Emergency Medical ◽

Number Of Patients ◽

Suspected Stroke ◽

The Impact

Introduction: The impact of prehospital triage of stroke mimics to designated stroke centers may be considerable, yet little information exists regarding stroke mimics in the prehospital setting. We aimed to describe the rate and clinical characteristics of neurological and non-neurological stroke mimics transported by Emergency Medical Services (EMS) to the Emergency Department (ED) for acute stroke evaluation. Methods: A retrospective, cross-sectional, observational analysis of a centralized EMS database of patients transported by EMS to the ED for suspected stroke during an 18-month period. Hospital charts and neuroimaging were utilized to determine the final diagnosis (acute stroke, stroke mimic, as well as specific underlying diagnoses). Results: A total of 960 patients were transported by EMS to the ED with suspected stroke, among whom 405 (42.2%) were stroke mimics (mean age ± SD: 66.9 ± 17.1 years; 54% male). Stroke mimics were neurological in origin in 223 (55.1%) patients and non-neurological in 182 (44.9%). Most common neurological diagnoses were seizures (n=44,19.7%), migraines (n=42,18.8%) and peripheral neuropathies (n=25, 11.2%). Most common non-neurological mimics included cardiovascular (15.9%), psychiatric (11.9%), and infectious (8.9%) diagnoses. Neurological mimics were younger (64.1 ± 17.3 years) than non-neurological mimics (70.5 ± 16.1 years, p<0.001). Median prehospital Glasgow Coma Scale scores were similar between groups (15 vs. 15, p=0.26). Mean prehospital systolic blood pressure was slightly higher in neurological (147.8±24.2 mmHg) than non-neurological mimics (141.2±26.2 mmHg, p=0.01). Conclusions: Stroke mimics represent a substantial number of patients transported by EMS for suspected stroke, with a considerable amount being non-neurological in origin. Prospective prehospital studies are warranted to help refine prehospital identification of acute stroke and thus minimize the number of stroke mimics transported by EMS for acute stroke evaluation.

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Why People Do, or Do Not, Immediately Contact Emergency Medical Services following the Onset of Acute Stroke: Qualitative Interview Study

PLoS ONE ◽

10.1371/journal.pone.0046124 ◽

2012 ◽

Vol 7 (10) ◽

pp. e46124 ◽

Cited By ~ 21

Author(s):

Joan E. Mackintosh ◽

Madeleine J. Murtagh ◽

Helen Rodgers ◽

Richard G. Thomson ◽

Gary A. Ford ◽

...

Keyword(s):

Acute Stroke ◽

Emergency Medical Services ◽

Qualitative Interview ◽

Interview Study ◽

Medical Services ◽

Emergency Medical ◽

Qualitative Interview Study

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Emergency Medical Services Utilization for Acute Stroke Care: Analysis of the Paul Coverdell National Acute Stroke Program, 2014-2019

Prehospital Emergency Care ◽

10.1080/10903127.2021.1877856 ◽

2021 ◽

pp. 1-7

Author(s):

Ganesh Asaithambi ◽

Xin Tong ◽

Kamakshi Lakshminarayan ◽

Sallyann M. Coleman King ◽

Mary G. George ◽

...

Keyword(s):

Acute Stroke ◽

Emergency Medical Services ◽

Stroke Care ◽

Medical Services ◽

Acute Stroke Care ◽

Services Utilization ◽

Emergency Medical ◽

Medical Services Utilization

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Impact of COVID-19 on Emergency Medical Services for Patients with Acute Stroke Presentation in Busan, South Korea

Journal of Clinical Medicine ◽

10.3390/jcm11010094 ◽

2021 ◽

Vol 11 (1) ◽

pp. 94

Author(s):

Jiyoung Kim ◽

Choongrak Kim ◽

Song Yi Park

Keyword(s):

South Korea ◽

Acute Stroke ◽

Emergency Medical Services ◽

Processing Time ◽

Medical Services ◽

Processing Times ◽

Emergency Medical ◽

Number Of Patients ◽

Comprehensive Stroke Center ◽

The Impact

The purpose of this retrospective observational study was to identify the impact of COVID-19 on emergency medical services (EMS) processing times and transfers to the emergency department (ED) among patients with acute stroke symptoms before and during the COVID-19 pandemic in Busan, South Korea. The total number of patients using EMS for acute stroke symptoms decreased by 8.2% from 1570 in the pre-COVID-19 period to 1441 during the COVID-19 period. The median (interquartile range) EMS processing time was 29.0 (23–37) min in the pre-COVID-19 period and 33.0 (25–41) minutes in the COVID-19 period (p < 0.001). There was a significant decrease in the number of patients transferred to an ED with a comprehensive stroke center (CSC) (6.37%, p < 0.001) and an increase in the number of patients transferred to two EDs nearby (2.77%, p = 0.018; 3.22%, p < 0.001). During the COVID-19 pandemic, EMS processing time increased. The number of patients transferred to ED with CSC was significantly reduced and dispersed. COVID-19 appears to have affected the stroke chain of survival by hindering entry into EDs with stroke centers, the gateway for acute stroke patients.

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