The use of prehospital 12-lead electrocardiograms in acute stroke patients
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Abstract
AIM Emergency medical services (EMS) play a vital role in
the recognition, management and transportation of acute
stroke patients. UK guidelines recommend clinicians consider
performing a prehospital 12-lead electrocardiogram (PHECG)
in patients with suspected stroke , but this recommendation is
based on expert consensus, rather than robust evidence. The
aim of this study was to investigate the association between
PHECG and modified Rankin scale (mRS). Secondary outcomes included in-hospital mortality, EMS and in-hospital time
intervals and rates of thrombolysis received.
Method A multicentre retrospective cohort study was undertaken. The data collection period spanned from 29/12/2013 –
30/01/2017. Participants were identified through secondary
analysis of hospital data routinely collected as part of the Sentinel Stroke National Audit Programme (SSNAP) and linked to
EMS clinical records (PCRs) via EMS incident number.
Results PHECG was performed in 558 (48%) of study
patients. PHECG was associated with an increase in mRS
(aOR 1.44, 95% CI: 1.14 to 1.82, p=0.002) and in-hospital
mortality (aOR 2.07, 95% CI: 1.42 to 3.00, p=0.0001).
There was no association between PHECG and administration
of thrombolysis (aOR 0.92, 95% CI: 0.65 to 1.30, p=0.63).
Patients who had a PHECG recorded spent longer under the
care of EMS (median 49 vs 43 min, p=0.007). No difference
in times to receiving brain scan (Median 28 with PHECG vs
29 min no PHECG, p=0.14) or thrombolysis (median 46 min
vs 48 min, p=0.82) were observed.
Conclusion This is the first study of its kind to investigate the
association between PHECG and functional outcome in stroke
patients attended by EMS. Although there are limitations in
Abstracts
BMJ Open 2018;8(Suppl 1):A1–A34 A5
Trust (NHS). Protected by copyright.
on September 3, 2019 at Manchester University NHS Foundation http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2018-EMS.14 on 16 April 2018. Downloaded from
regard to the retrospective study design, the findings challenge
current guideline recommendations regarding PHECG in
patients with acute stroke.
https://bmjopen.bmj.com/content/bmjopen/8/Suppl_1/A5.3.full.pdf
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/bmjopen-2018-EMS.14