Acute stroke alert activation, emergency service use, and reperfusion therapy in Sweden

Abstract

ObjectivesAmbulance services and stroke alerts reduce the time from stroke onset to acute stroke diagnosis. We describe the use of stroke alerts and ambulance services in different hospitals and patient groups and their relationship with reperfusion therapy.MethodsThis nationwide study included 49,907 patients admitted with acute stroke who were registered in The Swedish Stroke Register (Riksstroke) in 2011–2012.ResultsThe proportions of patients admitted as stroke alerts out of all acute stroke admissions varied from 12.2% to 45.7% in university hospitals (n = 9), 0.5% to 38.7% in specialized nonuniversity hospitals (n = 22), and 4.2% to 40.3% in community hospitals (n = 41). Younger age, atrial fibrillation (AF), living in an institution, reduced consciousness upon admission, and hemorrhagic stroke were factors associated with a higher probability of stroke alerts. Living alone, primary school education, non‐European origin, previous stroke, diabetes, smoking, and dependency in activities of daily living (ADL) were associated with a lower probability of stroke alert. The proportion of patients arriving at the hospital by ambulance varied from 60.3% to 94.5%. Older age, living alone, primary school education, being born in a European country, previous stroke, AF, dependency in ADL, living in an institution, reduced consciousness upon admission, and hemorrhagic stroke were associated with ambulance services. Hospital stroke alert frequencies correlated strongly with reperfusion rates (r = .75).ConclusionAcute stroke alerts have a significant potential to improve stroke reperfusion rates. Prehospital stroke management varies conspicuously between hospitals and patient groups, and the elderly and patients living alone have a markedly reduced likelihood of stroke alerts.

Comparative Study on the Outcome of Stroke Patients Transferred by Doctor Helicopters and Ground Ambulances in South Korea: A Retrospective Controlled Study

“…We found that the transportation via HEMS is quicker than that via GEMS, and the transport time to the hospital from the site, the entire time it took for the patient to arrive at the hospital after the time of the incident, and the time to determine whether a patient will be admitted or not to the hospital were all shortened, which were similar to the result of Ringburg et al [ 13 ]. Indeed, our results are consistent with those of Eriksson et al [ 14 ], who stressed that they found treatment in hospitals is faster, i.e., within 3 hours, which significantly influenced the patient's prognosis. Using GEMS Gangwon province with mountainous terrain can be a disadvantage for saving time.…”

Socioeconomic disparities in prehospital stroke care

“…Other studies have used cut-off times to define delay. The most commonly used are hospital arrival beyond three or six hours from stroke onset, in which some studies have observed socioeconomic inequities [9, 14, 16, 17], while others have not [20, 22, 23]. One study [13] found socioeconomic disparities in prehospital delay when using two hours as the cut-off, while another study [21] reported no such disparities.…”

“…Our findings also provide indications of possible contributory factors to socioeconomic inequities in system delay. Prehospital recognition of stroke and TIA, high prehospital priority levels and activating stroke alerts are fundamental to reducing delay and improving reperfusion rates [9, 20]. To the best of our knowledge, there are no previous studies analysing the association between SES and prehospital priority levels.…”

“…Associations between SES and prehospital delay have been reported [9, 13–17], with a longer delay for patients with a low SES, although some other studies [18–23] found no association. Moreover, studies have reported varying results relating to the probability of ambulance use [9, 19, 24, 25] in different socioeconomic groups, while prehospital priority levels and prehospital recognition of stroke and TIA by ambulance personnel have rarely been examined. The evidence relating to the association between SES and system delay is therefore inconclusive and knowledge of the underlying causes of a prolonged delay in more disadvantaged populations is lacking.…”

Association between Area-Level Socioeconomic Deprivation and Prehospital Delay in Acute Ischemic Stroke Patients: An Ecological Study

“…Among the many risk factors of prehospital delay, some researchers believe that low socioeconomic status is one of the causes [ 8 , 9 ]. Moreover, some studies have found a significant relationship between prehospital delay and individual socioeconomic status (SES) status [ 7 , 10 , 11 ]. Other studies have explored the relationship between neighborhood/community SES and prehospital delay in AIS patients [ 12 , 13 ] with varying results.…”