The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study.
Emergency Medicine Journal · 2013-10-07 · Observational 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.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Communication & handover · Time intervals · Triage instruments · Urban
Related articles
- Effect of prehospital notification on acute stroke care: a multicenter study. (Scand J Trauma Resusc Emerg Med, 2016)
- Smartphone-Based Prehospital Stroke Triage Optimizes Workflow and Bridges the Off-Hour Delays in Endovascular Thrombectomy. (Cerebrovasc Dis, 2026)
- The Effect of Smartphone Pre-Notification System on Regional Acute Ischemic Stroke Management Time Delay: Multicenter Before-After Study. (Prehosp Emerg Care, 2026)
- Impact of Strengthened Collaboration with Emergency Medical Services and In-Hospital Workflow Optimization for Reducing Treatment Delays in Endovascular Thrombectomy. (J Neuroendovasc Ther, 2025)
- Video support for prehospital stroke consultation: implications for system design and clinical implementation from prehospital simulations. (BMC Med Inform Decis Mak, 2024)
- Effectiveness of the acute stroke care map program in reducing in-hospital delay for acute ischemic stroke in a Chinese urban area: an interrupted time series analysis. (Front Neurol, 2024)