scholarly journals Temporal Trends in Emergency Medical Services and General Practitioner Use for Acute Stroke After Australian Public Education Campaigns

Stroke ◽  
2018 ◽  
Vol 49 (12) ◽  
pp. 3078-3080 ◽  
Author(s):  
Janet E. Bray ◽  
Judith Finn ◽  
Peter Cameron ◽  
Karen Smith ◽  
Lahn Straney ◽  
...  
Keyword(s):  
General Practitioner ◽  
Public Education ◽  
Acute Stroke ◽  
Emergency Medical Services ◽  
Temporal Trends ◽  
Medical Services ◽  
Emergency Medical ◽  
Education Campaigns

scholarly journals Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients

2020 ◽  
Vol 9 (8) ◽  
pp. 2376
Author(s):  
Moritz Kielkopf ◽  
Thomas Meinel ◽  
Johannes Kaesmacher ◽  
Urs Fischer ◽  
Marcel Arnold ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Practitioner ◽  
Time Delay ◽  
Emergency Medical Services ◽  
Symptom Onset ◽  
Temporal Trends ◽  
Medical Services ◽  
Factors Associated ◽  
Emergency Medical ◽  
Suspected Stroke

(1) Background: The benefit of acute ischemic stroke (AIS) treatment declines with any time delay until treatment. Hence, factors influencing the time from symptom onset to admission (TTA) are of utmost importance. This study aimed to assess temporal trends and risk factors for delays in TTA. (2) Methods: We included 1244 consecutive patients from 2015 to 2018 with suspected stroke presenting within 24 h after symptom onset registered in our prospective, pre-specified hospital database. Temporal trends were assessed by comparing with a cohort of a previous study in 2006. Factors associated with TTA were assessed by univariable and multivariable regression analysis. (3) Results: In 1244 patients (median [IQR] age 73 [60–82] years; 44% women), the median TTA was 96 min (IQR 66–164). The prehospital time delay reduced by 27% in the last 12 years and the rate of patients referred by Emergency medical services (EMS) increased from 17% to 51% and the TTA for admissions by General Practitioner (GP) declined from 244 to 207 min. Factors associated with a delay in TTA were stroke severity (beta−1.9; 95% CI–3.6 to −0.2 min per point NIHSS score), referral by General Practitioner (GP, beta +140 min, 95% CI 100–179), self-admission (+92 min, 95% CI 57–128) as compared to admission by emergency medical services (EMS) and symptom onset during nighttime (+57 min, 95% CI 30–85). Conclusions: Although TTA improved markedly since 2006, our data indicates that continuous efforts are mandatory to raise public awareness on the importance of fast hospital referral in patients with suspected stroke by directly informing EMS, avoiding contact of a GP, and maintaining high effort for fast transportation also in patients with milder symptoms.

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

Stroke ◽  
2014 ◽  
Vol 45 (5) ◽  
pp. 1275-1279 ◽  
Author(s):  
David Curfman ◽  
Lisa Tabor Connor ◽  
Hawnwan Philip Moy ◽  
Laura Heitsch ◽  
Peter Panagos ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Emergency Medical

Factors Associated with Delay of Emergency Medical Services Activation in Patients with Acute Stroke

2021 ◽  
Vol 30 (1) ◽  
pp. 105426
Author(s):  
Ah Ram Seo ◽  
Hwan Song ◽  
Woon Jeong Lee ◽  
Kyu Nam Park ◽  
Jundong Moon ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Factors Associated ◽  
Emergency Medical

scholarly journals Variability in Criteria for Emergency Medical Services Routing of Acute Stroke Patients to Designated Stroke Center Hospitals

2015 ◽  
Vol 16 (5) ◽  
pp. 743-746 ◽  
Author(s):  
Nikolay Dimitrov ◽  
William Koenig ◽  
Nichole Bosson ◽  
Sarah Song ◽  
Jeffrey Saver ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Stroke Center

Out-of-Hospital Stroke Screen Accuracy in a State With an Emergency Medical Services Protocol for Routing Patients to Acute Stroke Centers

2014 ◽  
Vol 64 (5) ◽  
pp. 509-515 ◽  
Author(s):  
Andrew W. Asimos ◽  
Shana Ward ◽  
Jane H. Brice ◽  
Wayne D. Rosamond ◽  
Larry B. Goldstein ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Emergency Medical

Diagnostic value of prehospital ECG in acute stroke patients

Neurology ◽  
2017 ◽  
Vol 88 (20) ◽  
pp. 1894-1898 ◽  
Author(s):  
Tobias Bobinger ◽  
Bernd Kallmünzer ◽  
Markus Kopp ◽  
Natalia Kurka ◽  
Martin Arnold ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Stroke Unit ◽  
Diagnostic Yield ◽  
Prehospital Care ◽  
Diagnostic Value ◽  
Medical Services ◽  
Ecg Monitoring ◽  
St Segment Elevation ◽  
Emergency Medical

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.

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 ◽  
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.

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

Stroke ◽  
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.

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

PLoS ONE ◽  
2012 ◽  
Vol 7 (10) ◽  
pp. e46124 ◽  
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

Utilization of Emergency Medical Services in a Large Urban Area: Description of Call Types and Temporal Trends

2011 ◽  
Vol 15 (3) ◽  
pp. 371-380 ◽  
Author(s):  
Kevin G. Munjal ◽  
Robert A. Silverman ◽  
John Freese ◽  
James D. Braun ◽  
Bradley J. Kaufman ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Urban Area ◽  
Temporal Trends ◽  
Medical Services ◽  
Large Urban Area ◽  
Emergency Medical
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