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    The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study

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    Author
    Sheppard, James P.
    Mellor, Ruth M.
    Greenfield, Sheila
    Mant, Jonathan
    Quinn, Tom
    Sandler, David
    Sims, Don
    Singh, Satinder
    Ward, Matthew
    McManus, Richard J.
    CLAHRC BBC investigators
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    Keyword
    Emergency Medical Services
    Stroke
    Neurologic Examination
    Time Factors
    Radiography
    Journal title
    Emergency Medicine Journal
    
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    URI
    http://hdl.handle.net/20.500.12417/66
    DOI
    10.1136/emermed-2013-203026
    Abstract
    Background Hospital prealerting in acute stroke improves the timeliness of subsequent treatment, but little is known about the impact of prehospital assessments on in-hospital care. Objective Examine the association between prehospital assessments and notification by emergency medical service staff on the subsequent acute stroke care pathway. Methods This was a cohort study of linked patient medical records. Consenting patients with a diagnosis of stroke were recruited from two urban hospitals. Data from patient medical records were extracted and entered into a Cox regression analysis to investigate the association between time to CT request and recording of onset time, stroke recognition (using the Face Arm Speech Test (FAST)) and sending of a prealert message. Results 151 patients (aged 71±15 years) travelled to hospital via ambulance and were eligible for this analysis. Time of symptom onset was recorded in 61 (40%) cases, the FAST test was positive in 114 (75%) and a prealert message was sent in 65 (44%). Following adjustment for confounding, patients who had time of onset recorded (HR 0.73, 95% CI 0.52 to 1.03), were FAST-positive (HR 0.54, 95% CI 0.37 to 0.80) or were prealerted (HR 0.26, 95% CI 0.18 to 0.38), were more likely to receive a timely CT request in hospital. Conclusions This study highlights the importance of hospital prealerting, accurate stroke recognition, and recording of onset time. Those not recognised with stroke in a prehospital setting appear to be excluded from the possibility of rapid treatment in hospital, even before they have been seen by a specialist. https://emj.bmj.com/content/32/2/93.long 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/emermed-2013-203026
    ae974a485f413a2113503eed53cd6c53
    10.1136/emermed-2013-203026
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    Publications - West Midlands Ambulance Service

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