Abstract:The symptom onset-to-brain imaging time was significantly shorter in case of EMS transportation, but most patients did not reach the hospital in time to be eligible for thrombolysis. Efforts are still needed to reduce delays, especially public education and EMS activation. These efforts should be combined with new approaches for the quality management of stroke patients.
“…Substantial evidence suggests that EMS use is associated with faster ED stroke evaluations 2,4 and increased opportunity for treatment with tPA. 3 Our results identified opportunity to improve EMS provider recognition by reducing the rate of missed strokes and false positives through more consistent application of the CPSS.…”
Section: Discussionmentioning
confidence: 99%
“…[1][2][3] These benefits likely stem in part from earlier activation of hospital stroke code processes through prearrival notification. 5 Therefore, accurate prehospital stroke recognition is a critical link in the stroke chain of recovery.…”
Section: Discussionmentioning
confidence: 99%
“…A mong patients with acute ischemic stroke (IS), transport by emergency medical services (EMS) has been associated with earlier arrival, 1 faster emergency department (ED) evaluations, [2][3][4] and improved rates and speed of tissue-type plasminogen activator (tPA) delivery. 3 These benefits stem, at least in part, from prearrival activation of stroke teams as a result of hospital prenotification by EMS.…”
Background and Purpose-Prehospital activation of in-hospital stroke response hastens treatment but depends on accurate emergency medical services (EMS) stroke recognition. We sought to measure EMS stroke recognition accuracy and identify clinical factors associated with correct stroke identification. Methods-Using EMS and hospital records, we assembled a cohort of EMS-transported suspect, confirmed, or missed ischemic stroke or transient ischemic attack cases. The sensitivity and positive predictive value (PPV) for EMS stroke recognition were calculated using the hospital discharge diagnosis as the gold standard. We used multivariable logistic regression analysis to determine the association between Cincinnati Prehospital Stroke Scale use and EMS stroke recognition. Results-During a 12-month period, 441 EMS-transported patients were enrolled; of which, 371 (84.1%) were EMSsuspected strokes and 70 (15.9%) were EMS-missed strokes. Overall, 264 cases (59.9%) were confirmed as either ischemic stroke (n=186) or transient ischemic attack (n=78). The sensitivity of EMS stroke recognition was 73.5% (95% confidence interval, 67.7-78.7), and PPV was 52.3% (95% confidence interval, 47.1-57.5). Sensitivity (84.7% versus 30.9%; P<0.0001) and PPV (56.2% versus 30.4%; P=0.0004) were higher among cases with Cincinnati Prehospital Stroke Scale documentation. In multivariate analysis, Cincinnati Prehospital Stroke Scale documentation was independently associated with EMS sensitivity (odds ratio, 12.0; 95% confidence interval, 5.7-25.5) and PPV (odds ratio, 2.5; 95% confidence interval, 1.3-4.7).
Conclusions-EMS providers recognized 3 quarters of the patients with ischemic stroke and transient ischemic attack;however, half of EMS-suspected strokes were false positives. Documentation of a Cincinnati Prehospital Stroke Scale was associated with higher EMS stroke recognition sensitivity and PPV.
“…Substantial evidence suggests that EMS use is associated with faster ED stroke evaluations 2,4 and increased opportunity for treatment with tPA. 3 Our results identified opportunity to improve EMS provider recognition by reducing the rate of missed strokes and false positives through more consistent application of the CPSS.…”
Section: Discussionmentioning
confidence: 99%
“…[1][2][3] These benefits likely stem in part from earlier activation of hospital stroke code processes through prearrival notification. 5 Therefore, accurate prehospital stroke recognition is a critical link in the stroke chain of recovery.…”
Section: Discussionmentioning
confidence: 99%
“…A mong patients with acute ischemic stroke (IS), transport by emergency medical services (EMS) has been associated with earlier arrival, 1 faster emergency department (ED) evaluations, [2][3][4] and improved rates and speed of tissue-type plasminogen activator (tPA) delivery. 3 These benefits stem, at least in part, from prearrival activation of stroke teams as a result of hospital prenotification by EMS.…”
Background and Purpose-Prehospital activation of in-hospital stroke response hastens treatment but depends on accurate emergency medical services (EMS) stroke recognition. We sought to measure EMS stroke recognition accuracy and identify clinical factors associated with correct stroke identification. Methods-Using EMS and hospital records, we assembled a cohort of EMS-transported suspect, confirmed, or missed ischemic stroke or transient ischemic attack cases. The sensitivity and positive predictive value (PPV) for EMS stroke recognition were calculated using the hospital discharge diagnosis as the gold standard. We used multivariable logistic regression analysis to determine the association between Cincinnati Prehospital Stroke Scale use and EMS stroke recognition. Results-During a 12-month period, 441 EMS-transported patients were enrolled; of which, 371 (84.1%) were EMSsuspected strokes and 70 (15.9%) were EMS-missed strokes. Overall, 264 cases (59.9%) were confirmed as either ischemic stroke (n=186) or transient ischemic attack (n=78). The sensitivity of EMS stroke recognition was 73.5% (95% confidence interval, 67.7-78.7), and PPV was 52.3% (95% confidence interval, 47.1-57.5). Sensitivity (84.7% versus 30.9%; P<0.0001) and PPV (56.2% versus 30.4%; P=0.0004) were higher among cases with Cincinnati Prehospital Stroke Scale documentation. In multivariate analysis, Cincinnati Prehospital Stroke Scale documentation was independently associated with EMS sensitivity (odds ratio, 12.0; 95% confidence interval, 5.7-25.5) and PPV (odds ratio, 2.5; 95% confidence interval, 1.3-4.7).
Conclusions-EMS providers recognized 3 quarters of the patients with ischemic stroke and transient ischemic attack;however, half of EMS-suspected strokes were false positives. Documentation of a Cincinnati Prehospital Stroke Scale was associated with higher EMS stroke recognition sensitivity and PPV.
“…Patients with acute ischemic stroke who activate emergency medical services (EMS) receive earlier and faster Emergency Department evaluations and are more likely to receive thrombolytic therapy with recombinant tissue plasminogen activator (t-PA) [1][2][3][4] . As a result, encouraging the public to activate EMS when stroke symptoms are recognized is a focal point of public education efforts for stroke [5] .…”
Background: Emergency dispatchers represent the first point of contact for patients activating an acute stroke response. Accurate dispatcher stroke recognition is associated with faster emergency medical services response time; however, stroke is often unrecognized during initial emergency calls. Stroke screening tools such as the Cincinnati Prehospital Stroke Scale have been shown to improve on-scene stroke recognition and thus have been proposed as a means to improve dispatcher accuracy. We conducted a systematic review of the accuracy of emergency dispatcher stroke recognition when employing stroke screening tools. Methods: We conducted a comprehensive search of Medline, EMBASE, CINAHL, and Cochrane databases to identify studies of dispatcher stroke recognition accuracy. Those that specifically reported dispatcher utilization of any validated stroke screening tools in isolation or in the context of a comprehensive screening algorithm such as the Medical Priority Dispatch System (MPDS) were potentially eligible. Studies that reported data sufficient for calculation of dispatcher sensitivity or positive predictive value (PPV) using a hospital-based stroke/transient ischemic attack diagnosis as the reference standard were included. Two independent reviewers determined study eligibility, assessed quality using the QUADAS 2 instrument, and abstracted data. Results: We identified 1,413 potential studies; 54 underwent full text review. Three retrospective and 4 prospective cohort studies enrolling a total of 16,382 patients met the inclusion criteria. Stroke screening tools included MPDS (n = 4), Face Arm Speech Time (n = 2), and a novel screening algorithm developed after analysis of emergency calls for stroke (n = 1). Regardless of the screening tool employed, dispatcher stroke recognition sensitivity was suboptimal (5 studies, range 41-83%) as was the PPV (7 studies, range 42-68%). Primary study limitations included application of variable reference standards and questions regarding exclusion of subjects. No studies directly compared stroke screening algorithms and no studies specifically examined stroke recognition among potential candidates for acute stroke therapies. Conclusion: Even when utilizing a stroke screening tool, the accuracy of stroke recognition by emergency dispatchers was suboptimal. More research is needed to identify the causes of poor dispatcher stroke recognition and should focus on potential candidates for time-dependent stroke treatment.
“…A review of emergency medical systems’ (EMS) activities in low and middle income countries (LMIN) reveals that EMS have difficulties in providing acceptable care. One reason is inadequate investments in infrastructure (vehicles and staff) [ 1 – 4 ], causing public distrust with the EMS and thus enhancing other means of transportation of patients to healthcare facilities [ 2 , 5 , 6 ]. Fig.…”
Background The objective of this paper is to evaluate the response times and outcome of patients in two groups of patients attended by permanently (PS) and temporarily stationed ambulances (TS) (fluid deployment).MethodsPatients transported and treated by EMS between March 21, 2012 and March 20, 2013 in a city with 1.7 million inhabitants (Shiraz, Iran) were studied. Using the same number of ambulances, patients were divided into two groups: transported by ambulances dispatched from permanent ambulance stations (PS) vs. dispatched from temporary locations (TS). Furthermore, due to a high discrepancy in the number of missions between PS and TS in this group, a pilot study was also conducted to confirm the first result. The results were statistically analyzed using various methods and compared with regard to mortality and response time.ResultsIn this study (both periods), ambulances dispatched from TS had a reduction of their mean response times by 2 min compare to ambulances dispatched from PS. The difference was statistically significant (p < 0.001–[95 % CI, 1.975, 2.025]). The pre-hospital mortality rate was also significantly lower for this group (p = 0.04–[95 % CI, 0.006, 0.012]).ConclusionsThe results of this study suggest that temporary deployment of ambulances reduce response times and may improve early survival rates in patients managed by EMS.
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