Emergency medical service in the stroke chain of survival

Chenaitia, Hichem; Lefevre, Oriane; Ho, Vanessa P.; Squarcioni, C.; Pradel, Vincent; Fournier, Marc; Toesca, Richard; Michelet, Pierre; Auffray, J.P.

doi:10.1097/mej.0b013e32835015ac

Cited by 21 publications

(29 citation statements)

References 13 publications

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“…This is consistent with a previous study, which evaluated the impact of speech impairment on utility and found that the mean utility for major stroke reduced from 0.34 to 0.26 after speech deficits were considered [18]. Indeed, speech problems are common in stroke survivors [22,23], and they can significantly impair patients' communication and quality of life. Therefore, it is crucial to include speech deficits in the descriptions of post-stroke health states.…”

Section: Discussionsupporting

confidence: 88%

Patient-reported health preferences of anticoagulant-related outcomes

Wang

Xie

Kong

et al. 2015

J Thromb Thrombolysis

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Strokes can have a catastrophic impact on patients' health-related quality of life (HRQoL). In addition to warfarin, two novel oral anticoagulants, i.e., dabigatran and rivaroxaban, have been approved to prevent strokes. This study aimed to use direct measures to elicit patient-reported utilities (i.e., preferences) for anticoagulant-related outcomes. A cross-sectional survey was administered to 100 patients taking warfarin in an anticoagulation clinic. Utilities for six long-term and four short-term anticoagulant-related health states were elicited by the visual analogue scale (VAS) and standard gamble (SG) methods. Health states with the highest SG-derived mean utility values were "well on rivaroxaban" (mean ± SD = 0.90 ± 0.15), "well on warfarin" (0.86 ± 0.17), and "well on dabigatran" (0.83 ± 0.18). Approximately half of the patients considered major ischemic stroke (-1.57 ± 6.77) and intracranial hemorrhage (-1.99 ± 6.98) to be worse than death. The percentages of patients who considered a particular health state worse than death ranged from 0 to 55 % among various health states assessed. The VAS had similar findings. Good logical consistency was observed in both VAS- and SG-derived utility values. Ischemic stroke and intracranial hemorrhage had a significant impact on patients' HRQoL. Greater variation in patients' preferences was observed for more severely impaired health states, indicating the need for individualized medical decision-making. In this study, both long-term and short-term health states were included in the utility assessment. The findings of this study can be used in cost-utility analysis of future anticoagulation therapies.

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Section: Discussionsupporting

confidence: 88%

Patient-reported health preferences of anticoagulant-related outcomes

Wang

Xie

Kong

et al. 2015

J Thromb Thrombolysis

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“…This is comparable to previously presented data of correct prehospital identification of 42-57% [13,15,21,22]. To improve access to thrombolysis, fast identification of stroke is imperative, thus stroke patients not captured by the EMCC are a pressing concern.…”

Section: Discussionsupporting

confidence: 73%

“…Another study of emergency calls reports fall/collapse (26%) followed by stroke (25%) as the first problem presented by the caller and FAST symptoms to be initially presented in less than 5% [13]. Also, general discomfort, chest pain, dyspnea, fall or vertigo were the main symptoms expressed in misdiagnosed stroke patients according to Chenaitia et al [15]. As the FAST test mainly captures symptoms from the anterior circulation, not all stroke patients are expected to have a positive FAST.…”

Section: Discussionmentioning

confidence: 99%

“…Also, patients arriving at an emergency department with a prenotified ambulance are more likely to receive examination and treatment earlier [10,11,12]. To identify stroke in the ambulance may be difficult and even more so at the EMCC ‘on the phone' [13,14,15]. Prehospital stroke tests with low interrate variability between paramedics and physicians such as the Face Arm Speech Time (FAST) test and the Cincinnati Prehospital Stroke Scale have been developed [16,17,18,19].…”

Section: Introductionmentioning

confidence: 99%

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Face Arm Speech Time Test Use in the Prehospital Setting, Better in the Ambulance than in the Emergency Medical Communication Center

Berglund¹,

Svensson

Wahlgren

et al. 2014

Cerebrovasc Dis

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Background: Prehospital identification of acute stroke increases the possibility of early treatment and good outcome. To increase identification of stroke, the Face Arm Speech Time (FAST) test was introduced in the Emergency Medical Communication Center (EMCC). This substudy aims to evaluate the implementation of the FAST test in the EMCC and the ambulance service. Methods: The study was conducted in the region of Stockholm, Sweden during 6 months. The study population consisted of all calls to the EMCC concerning patients presenting at least one FAST symptom or a history/finding making the EMCC or ambulance personnel to suspect stroke within 6 h. Positive FAST was compared to diagnosis at discharge. Positive predictive values (PPV) for a stroke diagnosis at discharge were calculated. Results: In all, 900 patients with a median age of 71 years were enrolled, 667 (74%) by the EMCC and 233 (26%) by the ambulances. At discharge, 472 patients (52%) were diagnosed with stroke/transient ischemic attack (TIA), 337 identified by the EMCC (71%) and 135 (29%) by the ambulances. The PPV for a discharge diagnosis of stroke/TIA was 51% (CI 47-54%) in EMCC-enrolled and 58% (CI 52-64%) in ambulance-enrolled patients. With a positive FAST the PPV of a correct stroke/TIA diagnosis increased to 56% (CI 52-61%) and 73% (CI 66-80%) in EMCC- and ambulance-enrolled patients, respectively. Positive FAST from EMCC was also found in 44% of patients with a nonstroke diagnosis at discharge. A stroke/TIA diagnosis at discharge but negative FAST was found in 58 and 27 patients enrolled by the EMCC and ambulances, respectively. Conclusions: The PPV of FAST is higher when used on the scene by ambulance than by EMCC. FAST may be a useful prehospital tool to identify stroke/TIA but has limitations as the test can be negative in true strokes, can be positive in nonstrokes, and FAST symptoms may be present but not identified in the emergency call. For the prehospital care situation better identification tools are needed.

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“…In each county ( département ), a SAMU ( Service d’Aide Médicale Urgente ) call centre coordinates pre-hospital EMS 24/7. One or more on-duty physicians counsel callers, dispatch the fire brigade, an ambulance or a mobile intensive care unit on site, and enquire into bed availability in hospitals accepting stroke patients [24]. Hospital stroke units manage patients either autonomously or via a telemedicine link with other hospitals.…”

Section: Methodsmentioning

confidence: 99%

Main barriers to effective implementation of stroke care pathways in France: a qualitative study

Gache

Leleu

Nitenberg

et al. 2014

BMC Health Serv Res

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BackgroundStroke Care Pathways (SCPs) aim to improve quality of care by providing better access to stroke units, rehabilitation centres, and home care for dependent patients. The objective of this study was to identify the main barriers to effective implementation of SCPs in France.MethodsWe selected 4 types of SCPs currently implemented in France that differed in terms of geographical location, population size, socio-economic conditions, and available health care facilities. We carried out 51 semi-structured interviews of 44 key health professionals involved in these SCPs and used the interview data to (i) create a typology of the organisational barriers to effective SCP implementation by axial coding, (ii) define barrier contents by vertical coding. The typology was validated by a panel of 15 stroke care professionals.ResultsFour main barriers to effective SCP implementation were identified: lack of resources (31/44 interviewees), coordination problems among staff (14/44) and among facilities (27/44), suboptimal professional and organisational practices (16/44), and inadequate public education about stroke (13/44). Transposition of the findings onto a generic SCP highlighted alternative care options and identified 10 to 17 barriers that could disrupt continuity of care.ConclusionLack of resources was considered to be the chief obstacle to effective SCP implementation. However, the main weakness of existing SCPs was poor communication and cooperation among health professionals and among facilities. We intend to use this knowledge to construct a robust set of quality indicators for use in SCP quality improvement initiatives, in comparisons between SCPs, and in the assessment of the effective implementation of clinical practice guidelines.

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Emergency medical service in the stroke chain of survival

Cited by 21 publications

References 13 publications

Patient-reported health preferences of anticoagulant-related outcomes

Patient-reported health preferences of anticoagulant-related outcomes

Face Arm Speech Time Test Use in the Prehospital Setting, Better in the Ambulance than in the Emergency Medical Communication Center

Main barriers to effective implementation of stroke care pathways in France: a qualitative study

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