The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study
Sheppard, James P. Mellor, Ruth M. Greenfield, Sheila Mant, Jonathan Quinn, Tom Sandler, David Sims, Don Singh, Satinder Ward, Matthew McManus, Richard J.
Sheppard, James P.
Mellor, Ruth M.
Greenfield, Sheila
Mant, Jonathan
Quinn, Tom
Sandler, David
Sims, Don
Singh, Satinder
Ward, Matthew
McManus, Richard J.
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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
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http://dx.doi.org/10.1136/emermed-2013-203026