Clinical Characteristics of Elderly Acute Ischemic Stroke Patients Calling Emergency Medical Services

Abstract

Background: Time is the most important determining factor in acute ischemic stroke (AIS) treatment. Calling emergency medical services (EMS) during an AIS can reduce the time until treatment. Although differences in clinical characteristics, including sex, have been studied in patients with acute coronary syndrome, limited data are available on the differences among patients with AIS who call EMS, especially elderly patients. Methods: Patients aged 65 years or older who had received a diagnosis of AIS within 1 week of hospitalization were recruited and analyzed within 24 hours after symptom onset between January 1, 2012 and December 31, 2015. Calls to EMS was assessed by self-report during an in-hospital interview and verified using structured chart reviews to determine clinical differences among patients calls to EMS. Results: Of the 1,002 patients studied, 414 patients (41.3%) called EMS. A similar percentage of women and men with AIS called EMS (43.1% and 39.3%, respectively). The group calls to EMS had a faster median arrival time at the hospital (159 minutes vs. 793 minutes) and higher National Institutes of Health Stroke Scale (NIHSS) score (8.2±6.25 vs. 4.28±3.73). After adjusting for sociodemographic factors, EMS users were found to have shorter median onset-to-door time and higher NIHSS scores (odds ratio [OR], 3.538; 95% confidence interval [CI], p<0.01, and OR, 3.336; 95% CI, p<0.05, respectively). Conclusion: Our study suggests that calls to EMS reduces prehospital delay and expedites treatment for stroke. We expect that a wide-ranging and specialized educational program for increasing EMS use and enhancing stroke knowledge will lead to early hospital arrival for all age groups.