Patterns of Emergency Medical Services Use and Its Association With Timely Stroke Treatment

Abstract

Background-Prior studies found that only about half of stroke patients arrived at hospitals via emergency medical services (EMSs), yet since then, there have been efforts to increase public awareness that time is brain. Using contemporary Get With the Guidelines-Stroke data, we assessed nationwide EMS use by stroke patients. Methods and Results-We analyzed data from 204 591 patients with ischemic and hemorrhagic stroke admitted to 1563 GetWith the Guidelines-Stroke participating hospitals with data on National Institute of Health Stroke Score and insurance status. Hospital arrival by EMSs was observed in 63.7% of patients. Older patients, those with Medicaid and Medicare insurance, and those with severe stroke were more likely to activate EMSs. In contrast, minority race and ethnicity and living in rural communities were associated with decreased odds of EMS use. EMS transport was independently associated with earlier arrival (onset-to-door time, ≤3 hours; adjusted odds ratio, 2.00; 95% confidence interval, 1.93-2.08), prompter evaluation (more patients with door-to-imaging time, ≤25 minutes; odds ratio, 1.89; 95% confidence interval, 1.78-2.00), more rapid treatment (more patients with door-to-needle time, ≤60 minutes; odds ratio, 1.44; 95% confidence interval, 1.28-1.63), and more eligible patients to be treated with tissue-type plasminogen activator if onset is ≤2 hours (67% versus 44%; odds ratio, 1.47; 95% confidence interval, 1.33-1.64). Conclusions-Although EMS use is independently associated with more rapid evaluation and treatment of stroke, more than one third of stroke patients fail to use EMSs. Interventions aimed at increasing EMS activation should target populations at risk, particularly younger patients and those of minority race and ethnicity. (Circ Cardiovasc Qual Outcomes. 2013;6:262-269.)

Determinants of Emergency Medical Services Utilization Among Acute Ischemic Stroke Patients in Hubei Province in China

“…12,13 However, we found that patients with a history of stroke were less likely to use EMS, which was inconsistent with previous reports showing no association between previous stroke and EMS utilization. 12 It was worth noting that the most powerful factor associated with increased EMS utilization was previous use of EMS. Patients with experience in using EMS may have greater awareness of the importance of appropriate use of EMS for acute stroke symptoms, and they may also have better knowledge about how to use it.…”

Door-to-Imaging Time for Acute Stroke Patients Is Adversely Affected by Emergency Department Crowding

“…Arrival by emergency medical services was associated with improved DAT and DIT, 7,8 and patient factors such as blood pressure, blood glucose, National Institutes of Health Stroke Scale score of >2, intubation/high oxygen requirement, and sex were found to be significant factors that predicted activation and imaging times. [8][9][10] Interestingly, time cycle factors were significant in our study, contrasting previous research showing no association between DIT and time of day or day of week.…”

“…5,6 Mode of patient arrival (emergency medical services versus private vehicle) is another care process known to affect DIT. 7,8 In addition, patient-specific factors, including sex, symptom severity, symptom duration, history of diabetes mellitus, and initial blood pressure, also are reported to affect DIT. [8][9][10] Although research related to DIT in stroke is extensive, it has focused primarily on process-specific and patient-specific factors.…”

Strategies Used by Hospitals to Improve Speed of Tissue-Type Plasminogen Activator Treatment in Acute Ischemic Stroke

“…[11][12][13][14][15][16][17][18][19][20][21][22][23][24] However, the extent to which hospitals are using these strategies has not been well studied. More importantly, it is not clear which strategies are most effective.…”