Not a Minute to Spare: Balancing Accuracy and Efficiency in Prehospital Stroke Management

Abstract

mergency medical services (EMS) are frequently the first medical contact to evaluate patients experiencing ischemic or hemorrhagic stroke symptoms. EMS provides first medical contact for 35% to 75% of all patients with stroke. 1,2 Prehospital Stroke Scale emerged in the mid-1990s with the development and validation of the Los Angeles Prehospital Stroke Scale, the Cincinnati Prehospital Stroke Scale, and then Face, Arms, Speech, Time acronym. Several stroke evaluation tools have been developed and several are used in the United States and internationally based on region and protocol, with varying accuracy. EMS will miss a meaningful number of strokes with these tools. [3][4][5][6] Because of this data, there is continued effort to make prehospital recognition of stroke symptoms and prehospital stroke management more accurate and efficient to improve door-to-needle times and improve patient outcomes. In this issue of Stroke, Oostema and colleagues 7 used 7 metrics adopted by the National EMS quality alliance to determine quality of stroke care and if adoption of these metrics improved door to computed tomography (CT) time, door to needle time, and more importantly, patient outcomes. Using a retrospective cohort of EMS-transported confirmed-stroke patients in Michigan, the research team found that 5 documented steps (Prehospital Stroke Scale documentation, point-of-care glucose check, transport time <15 minutes, hospital prenotification, and intravenous placement) were independently associated with improved time to CT. Using these positively associated metrics, the authors developed a score system to quantify the quality of prehospital stroke care. Using random effects logistic regression, an incremental 1-point higher score was associated with a linear improvement in time to CT, with The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.