Dataset Information

The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study.

ABSTRACT:

Background

Hospital prealerting in acute stroke improves the timeliness of subsequent treatment, but little is known about the impact of prehospital assessments on in-hospital care.

Objective

Examine the association between prehospital assessments and notification by emergency medical service staff on the subsequent acute stroke care pathway.

Methods

This was a cohort study of linked patient medical records. Consenting patients with a diagnosis of stroke were recruited from two urban hospitals. Data from patient medical records were extracted and entered into a Cox regression analysis to investigate the association between time to CT request and recording of onset time, stroke recognition (using the Face Arm Speech Test (FAST)) and sending of a prealert message.

Results

151 patients (aged 71±15 years) travelled to hospital via ambulance and were eligible for this analysis. Time of symptom onset was recorded in 61 (40%) cases, the FAST test was positive in 114 (75%) and a prealert message was sent in 65 (44%). Following adjustment for confounding, patients who had time of onset recorded (HR 0.73, 95% CI 0.52 to 1.03), were FAST-positive (HR 0.54, 95% CI 0.37 to 0.80) or were prealerted (HR 0.26, 95% CI 0.18 to 0.38), were more likely to receive a timely CT request in hospital.

Conclusions

This study highlights the importance of hospital prealerting, accurate stroke recognition, and recording of onset time. Those not recognised with stroke in a prehospital setting appear to be excluded from the possibility of rapid treatment in hospital, even before they have been seen by a specialist.

SUBMITTER: Sheppard JP

PROVIDER: S-EPMC4316848 | biostudies-literature | 2015 Feb

REPOSITORIES: biostudies-literature

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Publications

The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study.

Sheppard James P JP Mellor Ruth M RM Greenfield Sheila S Mant Jonathan J Quinn Tom T Sandler David D Sims Don D Singh Satinder S Ward Matthew M McManus Richard J RJ

Emergency medicine journal : EMJ 20131007 2

<h4>Background</h4>Hospital prealerting in acute stroke improves the timeliness of subsequent treatment, but little is known about the impact of prehospital assessments on in-hospital care.<h4>Objective</h4>Examine the association between prehospital assessments and notification by emergency medical service staff on the subsequent acute stroke care pathway.<h4>Methods</h4>This was a cohort study of linked patient medical records. Consenting patients with a diagnosis of stroke were recruited from ...[more]

PMID: 24099829

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Project description:BackgroundEmergency medical services (EMS) are the first health care contact for the majority of stroke patients. However, there is a lack of data on the current paramedics' hospital-directed feedback and training needs across different health care settings. We aimed to evaluate paramedics' prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke patients.MethodsWe surveyed paramedics from the Vilnius region from September to November 2019 and compared the answers between the city and the district agencies. The questionnaire content included questions on paramedics' demographic characteristics, prehospital stroke care self-assessment, knowledge on stroke mimics, stroke training needs, and the importance of hospital-directed feedback on suspected stroke patients.ResultsA total number of 161 paramedics (or 49.4% of all paramedics from our stroke care network) were surveyed, with more district paramedics rating their prehospital stroke care knowledge as inadequate (44.8% (95% confidence interval (CI) 32.8-57.6) vs. 28.1% (95% CI 20.1-27.8), p = 0.028). In addition, more district paramedics indicated a need for additional stroke training (83.1% (95% CI 71.5-90.5) vs. 69.8% (60.0-78.1), p = 0.043). However, respondents reported being the most confident while dealing with stroke (71.3%, 95% CI 63.8-77.7) compared to other time-critical conditions (p < 0.001). Vertigo (60.8%, 95% CI 53.0-68.0), brain tumors (56.3%, 95% CI 48.5-63.8), and seizures (54.4%, 95% CI 46.7-62.0) were indicated as the most common stroke mimics. Only 6.2% (95% CI 3.4-11.1) of respondents received formal feedback on the outcome of suspected stroke patients brought to the emergency department.ConclusionsA high proportion of paramedics self-perceive having inadequate stroke knowledge and an urgent need for further stroke training. The EMS staff indicate receiving insufficient feedback on suspected stroke patients, even though its usefulness is perceived as paramount.

Project description:ObjectivesThis study aimed to compare hospital admission and 30-day mortality between patients assessed by the prehospital assessment unit (PAU) and patients not assessed by the PAU.DesignThis was a matched cohort study.SettingThis study was conducted between November 2021 and October 2022 in Region Zealand, Denmark.Participants989 patients aged >18, assessed by the PAU, were identified, and 9860 patients not assessed by the PAU were selected from the emergency calls using exposure density sampling.ExposurePatients assessed by the PAU. The PAU is operated by paramedics with access to point-of-care test facilities. The PAU is an alternative response vehicle without the capability of transporting patients.Primary and secondary outcome measuresThe primary outcome was hospital admission within 48 hours after the initial call. The key secondary outcomes were admission within 7 days, 30-day mortality and admission within 6 hours. Descriptive statistical analyses were conducted, and logistic regression models were used to estimate adjusted OR (aOR) and 95% CI.ResultsAmong the PAU assessed, 44.1% were admitted within 48 hours, compared with 72.9% of the non-PAU assessed, p<0.001. The multivariable analysis showed a lower risk of admission within 48 hours and 7 days among the PAU patients, aOR 0.31 (95% CI 0.26 to 0.38) and aOR 0.50 (95% CI 0.38 to 0.64), respectively. The 30-day mortality rate was 3.8% in the PAU-assessed patients vs 5.5% in the non-PAU-assessed patients, p=0.03. In the multivariable analysis, no significant difference was found in mortality aOR 0.99 (95% CI 0.71 to 1.42). No deaths were observed in PAU-assessed patients without subsequent follow-up.ConclusionThe recently introduced PAU aims for patient-centred emergency care. The PAU-assessed patients had reduced admissions within 48 hours and 7 days after the initial call. Study findings indicate that the PAU is safe since we identified no significant differences in 30-day mortality.Trial registration numberNCT05654909.

Dataset Information

The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study.

Background

Objective

Methods

Results

Conclusions

Publications

The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study.

Similar Datasets

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