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dc.contributor.authorSheppard, James P.
dc.contributor.authorMellor, Ruth M.
dc.contributor.authorGreenfield, Sheila
dc.contributor.authorMant, Jonathan
dc.contributor.authorQuinn, Tom
dc.contributor.authorSandler, David
dc.contributor.authorSims, Don
dc.contributor.authorSingh, Satinder
dc.contributor.authorWard, Matthew
dc.contributor.authorMcManus, Richard J.
dc.contributor.authorCLAHRC BBC investigators
dc.date.accessioned2019-07-03T09:16:05Z
dc.date.available2019-07-03T09:16:05Z
dc.date.issued2015-02
dc.identifier.citationSheppard, James P. et al, 2015. The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study. Emergency medicine journal : EMJ, 32 (2), 93-9.en_US
dc.identifier.issn1472-0213
dc.identifier.issn1472-0205
dc.identifier.doi10.1136/emermed-2013-203026
dc.identifier.urihttp://hdl.handle.net/20.500.12417/66
dc.description.abstractBackground 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
dc.language.isoenen_US
dc.subjectEmergency Medical Servicesen_US
dc.subjectStrokeen_US
dc.subjectNeurologic Examinationen_US
dc.subjectTime Factorsen_US
dc.subjectImagingen_US
dc.titleThe association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort studyen_US
dc.typeJournal Article/Review
dc.source.journaltitleEmergency Medicine Journal : EMJen_US
dcterms.dateAccepted2019-06-27
rioxxterms.versionNAen_US
rioxxterms.versionofrecord10.1136/emermed-2013-203026en_US
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden_US
rioxxterms.licenseref.startdate2019-06-27
refterms.panelUnspecifieden_US
refterms.dateFirstOnline2013-10
html.description.abstractBackground 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-2013-203026en_US


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