A survey of UK paramedics’ views about their stroke training, current practice and the identification of stroke mimics

McClelland, Graham; Flynn, Darren; Rodgers, Helen; Price, Christopher

doi:10.29045/14784726.2017.2.1.4

Cited by 10 publications

(20 citation statements)

References 22 publications

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“…However, only a third of respondents marked having participated in lectures, seminars, or workshops and only one in ten paramedics participated in university-based curriculum and conferences. Similar stroke continuing professional development proportions were found in a UK paramedics’ survey, although involvement in any continuing professional development training was at least twice as high [ 14 ].…”

Section: Discussionsupporting

confidence: 62%

“…To elucidate the factors associated with paramedics’ prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke outcomes, we reviewed the current literature on paramedic surveys concerning stroke care. We chose the questionnaire to be based on a survey of the United Kingdom’s (UK) paramedics, conducted by McClelland et al [ 14 ], which aligned with our predefined research goals. A Lithuanian version of the survey was used, adapted to the Lithuanian prehospital setting.…”

Section: Methodsmentioning

confidence: 99%

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Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

et al. 2022

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Background: Emergency medical services (EMS) are the first health care contact for the majority of stroke patients. However, there is a lack of data on the current paramedics’ hospital-directed feedback and training needs across different health care settings. We aimed to evaluate paramedics’ prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke patients. Methods: We surveyed paramedics from the Vilnius region from September to November 2019 and compared the answers between the city and the district agencies. The questionnaire content included questions on paramedics’ demographic characteristics, prehospital stroke care self-assessment, knowledge on stroke mimics, stroke training needs, and the importance of hospital-directed feedback on suspected stroke patients. Results: A total number of 161 paramedics (or 49.4% of all paramedics from our stroke care network) were surveyed, with more district paramedics rating their prehospital stroke care knowledge as inadequate (44.8% (95% confidence interval (CI) 32.8–57.6) vs. 28.1% (95% CI 20.1–27.8), p = 0.028). In addition, more district paramedics indicated a need for additional stroke training (83.1% (95% CI 71.5–90.5) vs. 69.8% (60.0–78.1), p = 0.043). However, respondents reported being the most confident while dealing with stroke (71.3%, 95% CI 63.8–77.7) compared to other time-critical conditions (p < 0.001). Vertigo (60.8%, 95% CI 53.0–68.0), brain tumors (56.3%, 95% CI 48.5–63.8), and seizures (54.4%, 95% CI 46.7–62.0) were indicated as the most common stroke mimics. Only 6.2% (95% CI 3.4–11.1) of respondents received formal feedback on the outcome of suspected stroke patients brought to the emergency department. Conclusions: A high proportion of paramedics self-perceive having inadequate stroke knowledge and an urgent need for further stroke training. The EMS staff indicate receiving insufficient feedback on suspected stroke patients, even though its usefulness is perceived as paramount.

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Section: Discussionsupporting

confidence: 62%

Section: Methodsmentioning

confidence: 99%

Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

et al. 2022

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“…It is useful to understand what elements of the pathway are breached when arriving at both HASUs and District Stroke Centers, and how many of these are strokes. However, since practice across ambulance services is heterogeneous, new practices are not well disseminated and paramedics feel they can benefit from both more training and feedback on prehospital stroke care ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

“…This should be commended and the crews' decisions around these FAST negative presentations should be investigated to consider how the pathway could be adapted. It could also inform additional training for paramedics, which they would welcome ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

Differences in Characteristics and Ambulance Pathway Adherence Between Strokes and Mimics Presenting to a Large UK Centralized Hyper Acute Stroke Unit (HASU)

et al. 2021

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Background: In Greater Manchester (GM), prehospital clinicians use the Face Arm Speech Test (FAST) to identify suspected stroke patients alongside pathway exclusions. Within the centralized stroke service, patients with a suspected stroke are taken directly to a Hyper Acute Stroke Unit (HASU), often bypassing their local emergency department (ED). However, many of these patients are experiencing an illness that looks like a stroke but is not a stroke. The data collected in the prehospital setting is rarely used in research yet could give valuable insights into the performance of the pathway.Aim: To evaluate the presenting symptoms and final diagnoses of prehospital suspected strokes and to evaluate the adherence of prehospital stroke pathway exclusions.Methods: We analyzed data from all patients brought in by ambulance and admitted on the stroke pathway between 01/09/15 and 28/02/17. Patient demographics and all data recorded in the prehospital setting were evaluated to identify differences in stroke, TIA, and mimic patients. Pathway adherence was assessed according to whether the patient was local or out-of-area (OOA) and bypassed their local ED.Results: A total of 4,216 suspected strokes were identified: 2,213 (52.5%) had a final diagnosis of stroke, 492 (11.7%) experienced a transient ischemic attack (TIA), and 1,511 (35.8%) were stroke mimics. There were 714 (16.9%) patients that were identified as having at least one pathway exclusion or were FAST negative, of which 270 (37.8%) experienced a stroke. The proportion of strokes was significantly lower in those with a pathway exclusion (41.8 vs. 53.5%; p < 0.001) and the proportion of breaches tended to be comparable or higher in the local population.Discussion: There are high volumes of stroke mimics but identified differences indicate there is an opportunity to better utilize prehospital data. Ambulance clinicians were able to correctly overrule FAST negative results and the volume of these suggest that FAST alone may be too restrictive.

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“…[4,5] The FAST is a simple test looking for facial droop, arm weakness or slurred speech as common symptoms of stroke. It remains the test most commonly used by UK ambulance services [6] due to good sensitivity for anterior circulation stroke (79-97%), but the specificity is lower (13-88%). [7] As most symptom checklists do not include symptoms of posterior stroke, such as vertigo or visual deficits, guidelines also recommend that practitioners apply their clinical judgement which is likely to further reduce specificity.…”

Section: Introductionmentioning

confidence: 99%

Positive predictive value of stroke identification by ambulance clinicians in North East England: a service evaluation

et al. 2020

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Introduction/backgroundAccurate prehospital identification of patients who had an acute stroke enables rapid conveyance to specialist units for time-dependent treatments such as thrombolysis and thrombectomy. Misidentification leads to patients who had a ‘stroke mimic’ (SM) being inappropriately triaged to specialist units. We evaluated the positive predictive value (PPV) of prehospital stroke identification by ambulance clinicians in the North East of England.MethodsThis service evaluation linked routinely collected records from a UK regional ambulance service identifying adults with any clinical impression of suspected stroke to diagnostic data from four National Health Service hospital trusts between 1 June 2013 and 31 May 2016. The reference standard for a confirmed stroke diagnosis was inclusion in Sentinel Stroke National Audit Programme data or a hospital diagnosis of stroke or transient ischaemic attack in Hospital Episode Statistics. PPV was calculated as a measure of diagnostic accuracy.ResultsAmbulance clinicians in North East England identified 5645 patients who had a suspected stroke (mean age 73.2 years, 48% male). At least one Face Arm Speech Test (FAST) symptom was documented for 93% of patients who had a suspected stroke but a positive FAST was only documented for 51%. Stroke, or transient ischaemic attack, was the final diagnosis for 3483 (62%) patients. SM (false positives) accounted for 38% of suspected strokes identified by ambulance clinicians and included a wide range of non-stroke diagnoses including infections, seizures and migraine.DiscussionIn this large multisite data set, identification of patients who had a stroke by ambulance clinicians had a PPV rate of 62% (95% CI 61 to 63). Most patients who had a suspected stroke had at least one FAST symptom, but failure to document a complete test was common. Training for stroke identification and SM rates need to be considered when planning service provision and capacity.

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A survey of UK paramedics’ views about their stroke training, current practice and the identification of stroke mimics

Cited by 10 publications

References 22 publications

Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

Differences in Characteristics and Ambulance Pathway Adherence Between Strokes and Mimics Presenting to a Large UK Centralized Hyper Acute Stroke Unit (HASU)

Positive predictive value of stroke identification by ambulance clinicians in North East England: a service evaluation

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