Pre-Hospital Stroke Recognition Needs Improvement

Findings from a new study have revealed that there is room for improvement in pre-hospital stroke recognition among emergency medical services (EMS) personnel.

For their study, the researchers evaluated stroke data from January 1, 2016, to December 31, 2016, from the Loyola Stroke and EMS databases, comparing it with data from a previous Loyola analysis from October 31, 2010, to June 30, 2011.
________________________________________________________________________________

RELATED CONTENT
New Device Detects Severe Stroke in Seconds
Could PPIs Lead to First-Time Stroke?
________________________________________________________________________________

Specifically, data regarding initial EMS impression of stroke/non-stroke, stroke types, age, emergency department (ED) stroke code activation, time to stroke team consultation, and ED/final discharge diagnoses were examined.

The researchers also calculated sensitivities and specificities for EMS impression and ED/final diagnosis, applying the chi square statistic in order to determine significance. Subset analyses were performed by age, and door to stroke team consult times were compared between groups.

A total of 216 patients were transported to Virginia Commonwealth University Health from October 1, 2015, to September 30, 2016. Results indicated that average times for dispatch to scene arrival, arrival to departure from scene, and departure to hospital arrival were 5 minutes and 41 seconds, 18 minutes and 15 seconds, and 10 minutes, respectively. In addition, average door to needle time was found to be 35 minutes.

A total of 99 (46%) of 216 patients had a final diagnosis of stroke, of which 19 were hemorrhagic. Of 80 patients with a diagnosis of ischemic stroke, 36 (45%) received a tissue plasminogen activator and 18 (23%) underwent thrombectomy.

“Although EMS recognition of possible stroke somewhat improved (10% absolute difference), the improvement in hospital stroke team response rates to those EMS activated stroke codes was dramatic,” the researchers concluded.

“A greater focus on pre-hospital (EMS) stroke recognition is needed,” they added.

These findings were presented on April 22 at the 2018 American Academy of Neurology Annual Meeting in Los Angeles, California.

—Christina Vogt

Reference:

Schneck M, de la Pena P, Ruland S, Gomez C, Cichon M, Biller J. Pre-hospital stroke diagnosis accuracy: cross sectional comparison 2010/11 & 2016. Paper presented at: 2018 American Academy of Neurology Annual Meeting; April 21-27, 2018; Los Angeles, CA. https://submissions.mirasmart.com/AAN2018/itinerary/SearchResultsProgram.asp

SEE ALSO: Predicting Post-Stroke Walking Activity (Podcast)

Dr. George Fulk speaks about his study and how gait speed is affected after a stroke.

For more podcasts, click here.