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Urdaneta A, Fisk C, Tandel MD, Garcia A, Govindarajan P. Air Medical Transport for Acute Ischemic Stroke Patients: A Retrospective Cohort Study of National Trends Over an 8-Year Period. Air Med J 2023; 42:423-428. [PMID: 37996176 DOI: 10.1016/j.amj.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/21/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE Optimal management of ischemic stroke is time dependent. An understanding of patterns of air medical transport may identify disparities that could affect patient care. METHODS In this 8-year (2007-2014) observational, retrospective, cohort study, we abstracted a 20% national sample of Medicare data from patients ≥ 66 years of age hospitalized with a primary diagnosis of acute ischemic stroke who presented to the emergency department by ambulance (air or ground). RESULTS Among 149,751 hospitalized stroke patients who arrived by ambulance, the mean age was 81.6 years (standard deviation = 8.0 years), 62.1% were female (n = 93,007), and 86.3% were White (n = 129,268). Of these, 5,534 patients (3.7%) used any form of air ambulance. Air ambulance use (2007: 2.5%, 2014: 4.9%; P < .001) and arrival at certified stroke centers (2007: 40.3%, 2014: 63.2%; P < .001) increased over time. Air ambulance use was less likely among older patients (76-85 years and >85 years vs. 66-75 years; odds ratio [OR] = 0.68; 95% confidence interval [CI], 0.64-0.72 and OR = 0.34; 95% CI, 0.32-0.37, respectively) and all racial minorities except American Natives (OR = 2.07; 95% CI, 1.57-2.73) and more likely among sicker patients (Charlson Comorbidity Index ≥ 2 vs. 1, OR = 1.23; 95% CI, 1.09-1.38) and rural residents (OR = 1.34; 95% CI, 1.09-1.64). After adjustment for covariates, air ambulance use was associated with higher odds of thrombolysis (adjusted OR = 2.57; 95% CI, 2.38-2.79). CONCLUSION Air ambulance use is independently associated with increased thrombolysis use for stroke, but disparities exist in both air ambulance and thrombolysis use. Further research into underlying causes for these disparities would be beneficial for systems and public health-based interventions for improving outcomes for ischemic stroke.
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Affiliation(s)
- Alfredo Urdaneta
- Department of Emergency Medicine, Stanford Medicine, Palo Alto, CA
| | - Cameron Fisk
- Department of Emergency Medicine, Stanford Medicine, Palo Alto, CA
| | - Megha D Tandel
- Quantitative Sciences Unit, Department of Medicine, Stanford Medicine, Palo Alto, CA
| | - Ariadna Garcia
- Quantitative Sciences Unit, Department of Medicine, Stanford Medicine, Palo Alto, CA
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Tarantini L, Merzou F, Luley M, Rollmann A, Schwindling MP, Lesmeister M, Gläss M, Wollenburg J, Schwindling L, Fassbender K. Perceived performance of activities of daily living by stroke patients: key in decision to call EMS and outcomes. Front Neurol 2023; 14:1241391. [PMID: 37808509 PMCID: PMC10556741 DOI: 10.3389/fneur.2023.1241391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Until recently, public education campaigns aimed at improving help-seeking behavior by acute stroke patients have achieved only limited or even no effects. Better understanding of psychological factors determining help-seeking behavior may be relevant in the design of more effective future campaigns. Methods In this prospective, cross-sectional study, we interviewed 669 acute stroke patients within 72 h after hospital admission. The primary endpoint was the effect of psychological factors on the decision to call emergency medical services (EMS). Secondary endpoints were the effects of such factors on treatment rates and clinical improvement (difference between modified Rankin scale (MRS) scores at admission and at discharge). Results Only 48.7% of the study population called the EMS. Multivariate logistic and linear regression analyses revealed that perception of unimpaired performance of activities of daily living (ADL) was the only psychological factor that predicted EMS use and outcomes. Thus, patients who perceived only minor impairment in performing ADL were less likely to use EMS (odds ratio, 0.54 [95% confidence interval, 0.38-0.76]; p = 0.001), had lower treatment rates, and had less improvement in MRS scores (b = 0.40, p = 0.004). Additional serial mediation analyses involving ischemic stroke patients showed that perception of low impairment in ADL decreased the likelihood of EMS notification, thereby increasing prehospital delays, leading to reduced thrombolysis rates and, finally, to reduced clinical improvement. Conclusion Perception of unimpaired performance of ADL is a crucial barrier to appropriate help-seeking behavior after acute stroke, leading to undertreatment and less improvement in clinical symptoms. Thus, beyond improving the public's knowledge of stroke symptoms, future public education campaigns should focus on the need for calling the EMS in case of stroke symptoms even if daily activities do not seem to be severely impaired.
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Affiliation(s)
- Luca Tarantini
- Experimental Neuropsychology Unit, Department of Psychology, Saarland University, Saarbrücken, Germany
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Fatma Merzou
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Maxine Luley
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Aline Rollmann
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | | | - Martin Lesmeister
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Marietheres Gläss
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Jennifer Wollenburg
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Lenka Schwindling
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Klaus Fassbender
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
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Ding K, Chen H, Wang Y, Liu H, Ceceke B, Zhang W, Geng L, Deng G, Sun T, Zhang W, Wu Y. Emergency medical service utilization among acute ischemic stroke patients in Beijing: An observational study. Front Neurol 2022; 13:969947. [PMID: 36147042 PMCID: PMC9485477 DOI: 10.3389/fneur.2022.969947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/10/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate emergency medical service (EMS) utilization and its associated factors in patients with acute ischemic stroke (AIS), and further explore the urban-rural differences. Methods Medical records for AIS in all emergency departments in Beijing were obtained from the Beijing Emergency Care Database from January 2018 to December 2021. EMS utilization was described and factors associated with EMS use were examined by multivariable logistic regression models with the generalized estimating equations. Results were compared between urban and rural districts. Results A total of 24,296 AIS patients were included in the analysis, and 11,190 (46.1%) were transported to hospitals by EMS. The percentage of EMS usage in urban areas was significantly higher than that in rural areas (53.6 vs. 34.4%, P < 0.001). From 2018 to 2021, EMS utilization was on the increase (P-value for trend <0.001) with a higher average annual growth rate in rural areas (12.6%) than in urban (6.4%). Factors associated with EMS utilization were age (OR: 1.20 per 10-year increase, 95% CI: 1.17–1.23), NIHSS scores, off-hour arrival (OR: 1.32, 95% CI: 1.23–1.37), treatment in tertiary hospitals (OR: 1.75, 95% CI: 1.60–1.92), and possessing comorbidities such as coronary artery disease (OR: 1.15, 95% CI: 1.17–1.24), atrial fibrillation (OR: 1.56, 95% CI: 1.41–1.73), prior stroke (OR: 0.84, 95% CI: 0.78-0.90) or dyslipidemia (OR: 0.78, 95% CI: 0.71–0.85). Conclusion This study demonstrated an inadequate use of EMS among AIS patients in Beijing, especially in rural areas, and revealed several associated factors. Enhanced education programs and EMS accessibility are necessary particularly for high-risk individuals and regions.
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Affiliation(s)
- Kexin Ding
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Hui Chen
- Department of Internet Management and Quality Control, Beijing Emergency Medical Center, Beijing, China
| | - Yong Wang
- Beijing Emergency Medical Center, Beijing, China
| | - Hongmei Liu
- Beijing Emergency Medical Center, Beijing, China
| | - Bayier Ceceke
- Department of Internet Management and Quality Control, Beijing Emergency Medical Center, Beijing, China
| | - Wei Zhang
- Department of Internet Management and Quality Control, Beijing Emergency Medical Center, Beijing, China
| | - Ling Geng
- Department of Internet Management and Quality Control, Beijing Emergency Medical Center, Beijing, China
| | - Guifang Deng
- Department of Internet Management and Quality Control, Beijing Emergency Medical Center, Beijing, China
| | - Tao Sun
- Department of Internet Management and Quality Control, Beijing Emergency Medical Center, Beijing, China
| | | | - Yiqun Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Terecoasă EO, Radu RA, Negrilă A, Enache I, Cășaru B, Tiu C. Pre-Hospital Delay in Acute Ischemic Stroke Care: Current Findings and Future Perspectives in a Tertiary Stroke Center from Romania-A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1003. [PMID: 36013470 PMCID: PMC9415394 DOI: 10.3390/medicina58081003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 12/16/2022]
Abstract
Background and objectives: The time interval between stroke onset and hospital arrival is a major barrier for reperfusion therapies in acute ischemic stroke and usually accounts for most of the onset-to-treatment delay. The present study aimed to analyze the pre-hospital delays for patients with acute ischemic stroke admitted to a tertiary stroke center in Romania and to identify the factors associated with a late hospital arrival. Material and methods: The study population consisted of 770 patients hospitalized with the diagnosis of acute ischemic stroke in the University Emergency Hospital Bucharest during a 6-month period, between 1 January and 30 June 2018. Data regarding pre-hospital delays were prospectively collected and analyzed together with the demographic and clinical characteristics of the patients. Results: In total, 31.6% of patients arrived at the hospital within 4.5 h from stroke onset and 4.4% in time intervals between 4.5 and 6 h from the onset, and 28.7% of the patients reached the hospital more than 24 h after onset of symptoms. Transport to hospital by own means was the only factor positively associated with arrival to hospital > 4.5 h from stroke onset and more than doubled the odds of late arrival. Factors negatively associated with hospital arrival > 4.5 h after stroke onset were prior diagnosis of atrial fibrillation, initial National Institute of Health Stroke Scale (NIHSS) score ≥ 16 points, presence of hemianopsia, facial palsy and sensory disturbance. Factors increasing the odds of hospital arrival after 24 h from stroke onset were living alone and living in rural areas. Conclusions: Almost one in three ischemic stroke patients presenting to our center reaches hospital more than 24 h after onset of symptoms. These findings highlight the need for urgent measures to improve not only stroke awareness but also pre-hospital protocols in order to provide timely and appropriate care for our stroke patients.
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Affiliation(s)
- Elena Oana Terecoasă
- Department of Neurology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania; (E.O.T.); (A.N.); (I.E.); (B.C.); (C.T.)
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
| | - Răzvan Alexandru Radu
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
| | - Anca Negrilă
- Department of Neurology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania; (E.O.T.); (A.N.); (I.E.); (B.C.); (C.T.)
| | - Iulian Enache
- Department of Neurology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania; (E.O.T.); (A.N.); (I.E.); (B.C.); (C.T.)
| | - Bogdan Cășaru
- Department of Neurology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania; (E.O.T.); (A.N.); (I.E.); (B.C.); (C.T.)
| | - Cristina Tiu
- Department of Neurology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania; (E.O.T.); (A.N.); (I.E.); (B.C.); (C.T.)
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
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Dowbiggin PL, Infinger AE, Purick GT, Swanson DR, Asimos A, Rhoten JB, VonCannon S, Dometrovich M, Studnek JR. Prehospital Evaluation of the FAST-ED as a Secondary Stroke Screen to Identify Large Vessel Occlusion Strokes. PREHOSP EMERG CARE 2021; 26:333-338. [PMID: 34524065 DOI: 10.1080/10903127.2021.1979701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) was developed to identify Large Vessel Occlusion Strokes (LVOS) presenting out of hospital, although there is limited prospective research validating its use in this setting. This study evaluated the test characteristics of the FAST-ED to identify LVOS when used as a secondary stroke screen in the prehospital environment. Secondary analysis compared the performance of the CPSS and the FAST-ED in identifying an LVOS. Methods: This prospective, observational study was conducted from April 2018 to December 2019 in a municipal EMS system with all ALS ambulance response. The FAST-ED was implemented as a secondary screening tool for emergent stroke patients who had at least one positive Cincinnati Prehospital Stroke Screen (CPSS) item. CPSS and FAST-ED scores were extracted from prehospital electronic care reports, while the presence of LVOS was extracted from hospital records. Results: A total 1,359 patients were enrolled; 55.3% female, 47.5% white, with a mean age of 69.4 (SD 15.8). In this cohort, 11.3% of patients experienced an LVOS. The mean FAST-ED for a patient experiencing an LVOS was 5.33 (95%CI 4.97-5.69) compared to 3.06 (95%CI 2.95-3.12) (p < 0.001). A score of greater or equal to 4 yielded the highest combination of sensitivity (77.78%) and specificity (65.34%) with positive likelihood ratio 2.24 (95% CI 2.00-2.52) and negative likelihood ratio 0.34 (95% CI 0.25-0.46). Area under the ROC curve was 0.77 (95%CI 0.73, 0.81). A CPSS with all three items positive demonstrated a sensitivity of 73.20% and 69.57% specificity, with an ROC area of 0.73 (95% CI 0.70-0.77). When comparing a FAST-ED ≥4 to a CPSS of all positive items, there was no significant difference in sensitivity (p > 0.05), and the FAST-ED had a significantly lower specificity than the CPSS (p < 0.005). Conclusion: As stroke care advances, EMS agencies must consider their destination triage needs. This study suggests agencies must consider the use of single versus secondary scales, and to determine the ideal sensitivity and specificity for their system.
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Tansuwannarat P, Atiksawedparit P, Wibulpolprasert A, Mankasetkit N. Prehospital time of suspected stroke patients treated by emergency medical service: a nationwide study in Thailand. Int J Emerg Med 2021; 14:37. [PMID: 34281496 PMCID: PMC8287686 DOI: 10.1186/s12245-021-00361-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/06/2021] [Indexed: 01/01/2023] Open
Abstract
Background This work was to study the prehospital time among suspected stroke patients who were transported by an emergency medical service (EMS) system using a national database. Methods National EMS database of suspected stroke patients who were treated by EMS system across 77 provinces of Thailand between January 1, 2015, and December 31, 2018, was retrospectively analyzed. Demographic data (i.e., regions, shifts, levels of ambulance, and distance to the scene) and prehospital time (i.e., dispatch, activation, response, scene, and transportation time) were extracted. Time parameters were also categorized according to the guidelines. Results Total 53,536 subjects were included in the analysis. Most of the subjects were transported during 06.00-18.00 (77.5%) and were 10 km from the ambulance parking (80.2%). Half of the subjects (50.1%) were served by advanced life support (ALS) ambulance. Median total time was 29 min (IQR 21, 39). There was a significant difference of median total time among ALS (30 min), basic (27 min), and first responder (28 min) ambulances, Holm P = 0.009. Although 91.7% and 88.3% of the subjects had dispatch time ≤ 1 min and activation time ≤ 2 min, only 48.3% had RT ≤ 8 min. However, 95% of the services were at the scene ≤ 15 min. Conclusion Prehospital time from EMS call to hospital was approximately 30 min which was mainly utilized for traveling from the ambulance parking to the scene and transporting patients from the scene to hospitals. Even though only 48% of the services had RT ≤ 8 min, 95% of them had the scene time ≤ 15 min. Supplementary Information The online version contains supplementary material available at 10.1186/s12245-021-00361-w.
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Affiliation(s)
- Phantakan Tansuwannarat
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, 10540, Thailand
| | - Pongsakorn Atiksawedparit
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, 10540, Thailand.
| | - Arrug Wibulpolprasert
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Natdanai Mankasetkit
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, 10540, Thailand
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Gu S, Dai Z, Shen H, Bai Y, Zhang X, Liu X, Xu G. Delayed Stroke Treatment during COVID-19 Pandemic in China. Cerebrovasc Dis 2021; 50:715-721. [PMID: 34247153 PMCID: PMC8339026 DOI: 10.1159/000517075] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/17/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Social distance, quarantine, pathogen testing, and other preventive strategies implemented during CO-VID-19 pandemic may negatively influence the management of acute ischemic stroke (AIS). OBJECTIVE The current study aimed to evaluate the impacts of COVID-19 pandemic on treatment delay of AIS in China. METHODS This study included patients with AIS admitted in 2 hospitals in Jiangsu, China. Patients admitted before and after the COVID-19 pandemic outbreak (January 31, 2020, as officially announced by the Chinese government) were screened to collect sociodemographic data, medical history information, and symptom onset status from clinical medical records and compared for pre- (measured as onset-to-door time [ODT]) and posthospital delay (measured as door-to-needle time [DNT]). The influencing factors for delayed treatment (indicated as onset-to-needle time >4.5 h) were analyzed with multivariate logistic regression analysis. RESULTS A total of 252 patients were included, of which 153 (60.7%) were enrolled before and 99 (39.3%) after the COVID-19 pandemic. ODT increased from 202 min (interquartile range [IQR] 65-492) before to 317 min (IQR 75-790) after the COVID-19 pandemic (p = 0.001). DNT increased from 50 min (IQR 40-75) before to 65 min (IQR 48-84) after the COVID-19 pandemic (p = 0.048). The proportion of patients with intravenous thrombolysis in those with AIS was decreased significantly after the pandemic (15.4% vs. 20.1%; p = 0.030). Multivariate logistic regression analysis indicated that patients after COVID-19 pandemic, lower educational level, rural residency, mild symptoms, small artery occlusion, and transported by other means than ambulance were associated with delayed treatment. CONCLUSIONS COVID-19 pandemic has remarkable impacts on the management of AIS. Both pre- and posthospital delays were prolonged significantly, and proportion of patients arrived within the 4.5-h time window for intravenous thrombolysis treatment was decreased. Given that anti-COVID-19 measures are becoming medical routines, efforts are warranted to shorten the delay so that the outcomes of stroke could be improved.
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Affiliation(s)
- Shiyuan Gu
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, China
- Department of Neurology, Affiliated Yixing Hospital of Jiangsu University, Yixing, China
| | - Zhengze Dai
- Department of Neurology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing Pukou Hospital, Nanjing, China
| | - Huachao Shen
- Department of Neurology, BenQ Medical Center, Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Yongjie Bai
- Department of Neurology, First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Xiaohao Zhang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, China
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Gelin Xu
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, China
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Dowbiggin PL, Infinger AI, Purick G, Swanson DR, Studnek JR. Inter-Rater Reliability of the FAST-ED in the Out-of-Hospital Setting. PREHOSP EMERG CARE 2021:1-8. [PMID: 33205683 DOI: 10.1080/10903127.2020.1852350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 10/23/2022]
Abstract
Introduction: Patients experiencing a large vessel occlusion stroke (LVOS) may require endovascular-capable centers and benefit from direct transport to such facilities, creating a need for an accurate prehospital assessment. The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) is a secondary scale to identify LVOS. Currently, there is limited prospective evidence validating the use of the FAST-ED in the prehospital environment. This study aimed to evaluate the inter-rater reliability of the FAST-ED between patient care providers in the prehospital setting.Methods: This prospective study was conducted between 4/1/2018 and 7/1/2018 in a single municipal EMS agency that staffs two providers per ambulance with at least one being a paramedic. Patients were included based on paramedic impression that the patient was both having a stroke and greater than 18 years old. Each provider independently performed and documented a FAST-ED assessment on eligible patients. Data analysis consisted of performing inter-rater reliability using Cohen's Kappa on the FAST-ED score between primary and secondary providers. The FAST-ED was analyzed on an item level, an aggregate level (cumulative of all items), and using the defined cut point of ≥4. A sub-analysis determined if inter-rater reliability changed across provider certification.Results: There were 231 patients included in this analysis with an average age of 68.5 years and 135 (58.4%) female. Inter-rater reliability varied across individual items in the scale from 90.1% agreement to 82.5%. When analyzing inter-rater reliability of the aggregate FAST-ED score, the scale demonstrated 70.1% agreement (Kappa 0.66), considered substantial agreement. FAST-ED scores were analyzed using a cut point of ≥4. When using this cut point, there was 92.2% (Kappa 0.81) agreement between primary and secondary caregiver, demonstrating almost perfect agreement. Agreement was substantial across provider certifications including paramedics and EMTS.Conclusion: This study demonstrated high inter-rater reliability of the FAST-ED scale when performed in the prehospital setting on patients suspected of having a stroke. There were minimal differences in reliability based on provider certification, and item level analysis indicated substantial inter-rater reliability.
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Hasnain MG, Attia JR, Akter S, Rahman T, Hall A, Hubbard IJ, Levi CR, Paul CL. Effectiveness of interventions to improve rates of intravenous thrombolysis using behaviour change wheel functions: a systematic review and meta-analysis. Implement Sci 2020; 15:98. [PMID: 33148294 PMCID: PMC7641813 DOI: 10.1186/s13012-020-01054-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 10/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite being one of the few evidence-based treatments for acute ischemic stroke, intravenous thrombolysis has low implementation rates-mainly due to a narrow therapeutic window and the health system changes required to deliver it within the recommended time. This systematic review and meta-analyses explores the differential effectiveness of intervention strategies aimed at improving the rates of intravenous thrombolysis based on the number and type of behaviour change wheel functions employed. METHOD The following databases were searched: MEDLINE, EMBASE, PsycINFO, CINAHL and SCOPUS. Multiple authors independently completed study selection and extraction of data. The review included studies that investigated the effects of intervention strategies aimed at improving the rates of intravenous thrombolysis and/or onset-to-needle, onset-to-door and door-to-needle time for thrombolysis in patients with acute ischemic stroke. Interventions were coded according to the behaviour change wheel nomenclature. Study quality was assessed using the QualSyst scoring system for quantitative research methodologies. Random effects meta-analyses were used to examine effectiveness of interventions based on the behaviour change wheel model in improving rates of thrombolysis, while meta-regression was used to examine the association between the number of behaviour change wheel intervention strategies and intervention effectiveness. RESULTS Results from 77 studies were included. Five behaviour change wheel interventions, 'Education', 'Persuasion', 'Training', 'Environmental restructuring' and 'Enablement', were found to be employed among the included studies. Effects were similar across all intervention approaches regardless of type or number of behaviour change wheel-based strategies employed. High heterogeneity (I2 > 75%) was observed for all the pooled analyses. Publication bias was also identified. CONCLUSION There was no evidence for preferring one type of behaviour change intervention strategy, nor for including multiple strategies in improving thrombolysis rates. However, the study results should be interpreted with caution, as they display high heterogeneity and publication bias.
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Affiliation(s)
- Md Golam Hasnain
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, New South Wales Australia
| | - John R. Attia
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, New South Wales Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales Australia
- John Hunter Hospital, New Lambton Heights, New South Wales Australia
| | - Shahinoor Akter
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, New South Wales Australia
- Department of Anthropology, Jagannath University, Dhaka, Bangladesh
| | - Tabassum Rahman
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, New South Wales Australia
- Centre for Development, Economics and Sustainability, Monash University, Melbourne, Victoria Australia
| | - Alix Hall
- Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales Australia
| | - Isobel J. Hubbard
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, New South Wales Australia
| | - Christopher R. Levi
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, New South Wales Australia
- The Sydney Partnership for Health, Education, Research & Enterprise (SPHERE), Liverpool, New South Wales Australia
| | - Christine L. Paul
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, New South Wales Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales Australia
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Jaffe TA, Goldstein JN, Yun BJ, Etherton M, Leslie-Mazwi T, Schwamm LH, Zachrison KS. Impact of Emergency Department Crowding on Delays in Acute Stroke Care. West J Emerg Med 2020; 21:892-899. [PMID: 32726261 PMCID: PMC7390586 DOI: 10.5811/westjem.2020.5.45873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/05/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Delays in identification and treatment of acute stroke contribute to significant morbidity and mortality. Multiple clinical factors have been associated with delays in acute stroke care. We aimed to determine the relationship between emergency department (ED) crowding and the delivery of timely emergency stroke care. Methods We used prospectively collected data from our institutional Get with the Guidelines-Stroke registry to identify consecutive acute ischemic stroke patients presenting to our urban academic ED from July 2016–August 2018. We used capacity logs to determine the degree of ED crowding at the time of patients’ presentation and classified them as ordinal variables (normal, high, and severe capacity constraints). Outcomes of interest were door-to-imaging time (DIT) among patients potentially eligible for alteplase or endovascular therapy on presentation, door-to-needle time (DTN) for alteplase delivery, and door-to-groin puncture (DTP) times for endovascular therapy. Bivariate comparisons were made using t-tests, chi-square, and Wilcoxon rank-sum tests as appropriate. We used regression models to examine the relationship after accounting for patient demographics, transfer status, arrival mode, and initial stroke severity by the National Institutes of Health Stroke Scale. Results Of the 1379 patients with ischemic stroke presenting during the study period, 1081 (78%) presented at times of normal capacity, 203 (15%) during high ED crowding, and 94 (7%) during severe crowding. Median DIT was 26 minutes (interquartile range [IQR] 17–52); DTN time was 43 minutes (IQR 31–59); and median DTP was 58.5 minutes (IQR 56.5–100). Treatment times were not significantly different during periods of higher ED utilization in bivariate or in multivariable testing. Conclusion In our single institution analysis, we found no significant delays in stroke care delivery associated with increased ED crowding. This finding suggests that robust processes of care may enable continued high-quality acute care delivery, even during times with an increased capacity burden.
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Affiliation(s)
- Todd A Jaffe
- Harvard Affiliated Emergency Medicine Residency at Massachusetts General Hospital and Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Joshua N Goldstein
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Brian J Yun
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Mark Etherton
- Massachusetts General Hospital, Department of Neurology, Boston, Massachusetts
| | | | - Lee H Schwamm
- Massachusetts General Hospital, Department of Neurology, Boston, Massachusetts
| | - Kori S Zachrison
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
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11
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Li T, Cushman JT, Shah MN, Kelly AG, Rich DQ, Jones CMC. Prehospital time intervals and management of ischemic stroke patients. Am J Emerg Med 2020; 42:127-131. [PMID: 32059935 DOI: 10.1016/j.ajem.2020.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/06/2020] [Accepted: 02/06/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Quantify prehospital time intervals, describe prehospital stroke management, and estimate potential time saved if certain procedures were performed en route to the emergency department (ED). METHODS Acute ischemic stroke patients who arrived via emergency medical services (EMS) between 2012 and 2016 were identified. We determined the following prehospital time intervals: chute, response, on-scene, transport, and total prehospital times. Proportions of patients receiving the following were determined: Cincinnati Prehospital Stroke Scale (CPSS) assessment, prenotification, glucose assessment, vascular access, and 12-lead electrocardiography (ECG). For glucose assessment, ECG acquisition, and vascular access, the location (on-scene vs. en route) in which they were performed was described. Difference in on-scene times among patients who had these three interventions performed on-scene vs. en route was assessed. RESULTS Data from 870 patients were analyzed. Median total prehospital time was 39 min and comprised the following: chute time: 1 min; response time: 9 min; on-scene time: 15 min; and transport time: 14 min. CPSS was assessed in 64.7% of patients and prenotification was provided for 52.0% of patients. Glucose assessment, vascular access initiation, and ECG acquisition was performed on 84.1%, 72.6%, and 67.2% of patients, respectively. 59.0% of glucose assessments, 51.2% of vascular access initiations, and 49.8% of ECGs were performed on-scene. On-scene time was 9 min shorter among patients who had glucose assessments, vascular access initiations, and ECG acquisitions all performed en route vs. on-scene. CONCLUSIONS On-scene time comprised 38.5% of total prehospital time. Limiting on-scene performance of glucose assessments, vascular access initiations, and ECG acquisitions may decrease prehospital time.
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Affiliation(s)
- Timmy Li
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America.
| | - Jeremy T Cushman
- Department of Emergency Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America; Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Adam G Kelly
- Department of Neurology, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America
| | - David Q Rich
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America; Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America; Department of Environmental Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America
| | - Courtney M C Jones
- Department of Emergency Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America; Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America
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12
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Alhusain F, Alsuwailem H, Aldrees A, Bugis A, Alzuhairi S, Alsulami S, Arabi Y, Aljerian N. Does Being Transported by Emergency Medical Services Improve Compliance with the Surviving Sepsis Bundle and Mortality Rate? A Retrospective Cohort Study. J Epidemiol Glob Health 2019; 10:276-279. [PMID: 32959607 PMCID: PMC7758847 DOI: 10.2991/jegh.k.191215.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/11/2019] [Indexed: 11/16/2022] Open
Abstract
Background: This study aimed to investigate the relationship between patients with severe sepsis or septic shock being transported to the Emergency Department (ED) by Emergency Medical Services (EMS) and the compliance with the 3-h sepsis resuscitation bundle [Surviving Sepsis Campaign (SSC)], and to compare the management and laboratory results of patients transported by EMS or non-EMS transport. Methods: A retrospective cohort study was conducted using data from a quality-improvement project at King Abdulaziz Medical City in Riyadh. The data for patients who presented to ED with sepsis (severe sepsis or septic shock) was categorized as being transported with EMS or non-EMS. The two groups were compared in terms of compliance with the SSC bundle and 30-day mortality. Results: In a sample of 436 patients with severe sepsis or septic shock presented at the ED during the study period, EMS transported almost one-third of the patients (134, 31%) and 302 patients (69%) used non-EMS transport. For the EMS group, adherence to intravenous fluid was 91.4% compared with 87% for the non-EMS group (p = 0.19), antibiotics (EMS 50.7% vs non-EMS 52%, p = 0.81), blood cultures before antibiotics (EMS 53% vs non-EMS 47.4%, p = 0.21), and measuring lactate levels (EMS 73.1% vs non-EMS 57%, p = <0.01). The mortality rate was 48.5% for the EMS group and 54% for the non-EMS group, which was not statistically significant. Conclusion: Whether transported with or without EMS did not result in a statistically significant difference in patients presenting with sepsis, in terms of the adherence to the SSC bundle elements or the 30-day hospital mortality rate. The only statistically significant difference was the time to lactate measurement.
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Affiliation(s)
- Faisal Alhusain
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hanin Alsuwailem
- College of Medicine, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Alanoud Aldrees
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ahad Bugis
- College of Medicine, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Sarah Alzuhairi
- College of Medicine, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Sami Alsulami
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Emergency Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Yaseen Arabi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Intensive Care Unit Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Nawfal Aljerian
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Emergency Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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13
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ZHONG W, CHEN Z, CHEN H, XU D, WANG Z, HU H, WU C, ZHANG X, MA X, WANG Y, HU H, LOU M. [Effects of emergency medical service on prognosis of ischemic stroke patients treated with intravenous thrombolysis]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:241-246. [PMID: 31496154 PMCID: PMC8800684 DOI: 10.3785/j.issn.1008-9292.2019.06.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the effect of emergency medical service (EMS) on the prognosis of ischemic stroke patients treated with intravenous thrombolysis. METHODS Clinical data of 2123 ischemic stroke patients treated with intravenous thrombolysis in 70 hospitals in Zhejiang province were retrospectively analyzed. There were 808 patients sent to the hospital by ambulance (EMS group) and 1315 patients by other transportations (non-EMS group). Good outcome was defined as modified Rankin Scale (mRS) ≤ 2 at 3-month. The onset to needle time (ONT), onset to door time (ODT), door to needle time (DNT) and outcome were compared between EMS group and non-EMS group. Binary logistic regression was used to explore the influencing factors for the outcome at 3-month. RESULTS Compared with the non-EMS group, patients in the EMS group were older, with higher baseline National Institute of Health Sroke Scale (NIHSS) score, and had a higher proportion of atrial fibrillation (all P<0.05), but there were no significant differences in ONT, ODT and DNT between two groups (all P>0.05). Binary logistic regression showed that EMS was not independently associated with good outcome (OR=0.856, 95%CI:0.664-1.103, P>0.05). CONCLUSIONS EMS had not improve the outcome of patients receiving intravenous thrombolysis in Zhejiang province.
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Affiliation(s)
| | - Zhicai CHEN
- 陈智才(1986-), 男, 博士, 主治医师, 主要从事神经病学研究; E-mail:
;
https://orcid.org/0000-0003-4937-6749
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14
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Schewe JC, Kappler J, Dovermann K, Graeff I, Ehrentraut SF, Heister U, Hoeft A, Weber SU, Muenster S. Diagnostic accuracy of physician-staffed emergency medical teams: a retrospective observational cohort study of prehospital versus hospital diagnosis in a 10-year interval. Scand J Trauma Resusc Emerg Med 2019; 27:36. [PMID: 30940205 PMCID: PMC6446382 DOI: 10.1186/s13049-019-0617-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 03/20/2019] [Indexed: 02/06/2023] Open
Abstract
Background In Germany, emergency medical teams are staffed with physicians but evidence regarding their prehospital diagnostic accuracy remains poor. Objective To evaluate the out-of-hospital diagnostic accuracy of physician-staffed emergency medical teams (PEMTs). Methods A retrospective observational cohort study involving the Emergency Medical Service Bonn, Germany, from January to December 2004 and 2014 respectively. A total of 8346 patients underwent medical treatment by PEMTs, of which 1960 adult patients (inclusion criteria: ≥18 years of age, hospital diagnosis available) were included for further analysis. Reasons for non-inclusion: death on scene, outpatient, interhospital transfer, mental illness, false alarm, no hospital medical history available. The overall diagnostic accuracy (correct or false) of PEMTs was measured after matching the prehospital diagnosis with the corresponding diagnosis of the hospital. Secondary outcome measures were incidence of common PEMT diagnoses (acute coronary syndrome (ACS), dyspnea, stroke/intracerebral bleeding), recognition rate of a given disease by PEMTs, and prehospital diagnostic accuracy in elderly patients. Results PEMT calls increased 2-fold over a decade (2004: n = 3151 vs. 2014: n = 5195). Overall diagnostic accuracy of PEMTs increased from 87.5% in 2004 to 92.6% in the year 2014. The incidence of common PEMT diagnoses such as ACS, dyspnea or stroke/intracerebral bleeding increased 2-fold from 2004 to 2014. The recognition rate of a given disease by the PEMT varied between 2004 and 2014: an increase was observed when a stroke/intracerebral bleeding was diagnosed (2004: 67% vs. 2014: 83%; p = 0.054), a decreased rate of recognition occurred when a syncope/collapse was diagnosed (2004: 81% vs. 2014: 56%; p = 0.007) and a sepsis appears to be a rare event for EMS personnel (2004: 0% vs. 2014: 23%). Linear regression analysis revealed that the prehospital diagnostic accuracy decreases in the elderly patient. Conclusions The overall prehospital diagnostic accuracy of PEMTs improved between the year 2004 and 2014 respectively. Our findings suggest that the incidence of common diseases (ACS, dyspnea stroke/intracerebral bleeding, sepsis) increased over a 10-year period. Diagnostic accuracy of different diseases varied but generally decreased in the elderly patient. Regular training of EMS personnel and public campaigns should be implemented to improve the diagnostic accuracy in the future. Electronic supplementary material The online version of this article (10.1186/s13049-019-0617-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jens-Christian Schewe
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Jochen Kappler
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Katharina Dovermann
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Ingo Graeff
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.,Department of Emergency Medicine, Bonn, University Hospital Bonn, Bonn, Germany
| | - Stefan Felix Ehrentraut
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Ulrich Heister
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.,Emergency Medical Service Bonn, Bonn, Germany
| | - Andreas Hoeft
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Stefan Ulrich Weber
- Department of Anesthesiology, Critical Care and Pain Medicine, Heilig Geist Krankenhaus, Cologne, Germany
| | - Stefan Muenster
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.
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15
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Alegiani AC, Albrecht S, Rahn AC, Köpke S, Thomalla G, Heesen C. Reasons for delayed admission after stroke: results of a qualitative and quantitative survey. Patient Prefer Adherence 2019; 13:739-747. [PMID: 31190756 PMCID: PMC6514254 DOI: 10.2147/ppa.s193376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/23/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Acute stroke treatment shows time-dependent benefit to prevent disability. Public information campaigns and streamlining of emergency management have been performed, but still, only one-third of acute stroke patients are admitted >4.5 hrs after symptom onset. Patients and methods: We interviewed 15 patients, presenting >4.5 hrs after symptom onset, regarding symptom recognition, emotions and their first action after symptom onset. Recorded interviews were analyzed by standardized descriptive analysis. Based on the results, a quantitative survey was developed. One hundred consecutive stroke unit patients surveyed to compare patients presenting within 4.5 hrs and more than 4.5 hrs of symptom onset. Results: Patients predominantly noticed symptoms by themselves. The most commonly expressed feelings were uncertainty and shame. The most frequent action was waiting. Patients described moderate knowledge about stroke in general, but felt less informed regarding their stroke risk. Magazines (51%) were the most frequently indicated source of information, while general practitioners only accounted for 26%. Significantly better knowledge was shown in the answers on closed questions compared to open questions, although the same items were named. Conclusion: Shame, uncertainty and insufficient individual risk knowledge about stroke were the most important factors delaying admission after stroke. Individual risk counseling could be investigated to close the gap between general stroke knowledge and recognition of own stroke risk.
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Affiliation(s)
- Anna Christina Alegiani
- Department of Neurology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- Correspondence: Anna Christina AlegianiDepartment of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246Hamburg, GermanyEmail
| | - Sindy Albrecht
- Department of Neurology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Christin Rahn
- Institute of Social Medicine & Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
- Unit of Health Sciences and Education, MIN Faculty, University of Hamburg, Hamburg, Germany
| | - Sascha Köpke
- Institute of Social Medicine & Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Götz Thomalla
- Department of Neurology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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16
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Borrelli G, Koch E, Sterk E, Lovett S, Rech MA. Early recognition of sepsis through emergency medical services pre-hospital screening. Am J Emerg Med 2018; 37:1428-1432. [PMID: 30366742 DOI: 10.1016/j.ajem.2018.10.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The Surviving Sepsis Campaign implemented a 3-hour bundle including blood cultures, lactate, intravenous fluids, and antibiotics to improve mortality in sepsis. Though difficult to achieve, bundle compliance is associated with decreased hospital mortality. We predict that the implementation of an Emergency Medical Services (EMS) sepsis screening tool will improve 3-hour bundle compliance. OBJECTIVES To determine if pre-hospital sepsis screening improves 3-hour bundle compliance. METHODS Prospective implementation of an EMS sepsis screening tool (June 2016-November 2016) was compared to a historical control (August 2015-March 2016). The protocol was facilitated via communication between nurses and EMS personnel. The primary outcome was 3-hour bundle compliance. Secondary outcomes included time to individual bundle components. RESULTS Of 135 patients screened, 20 were positive and included in the study, and subsequently compared to 43 control patients. Baseline demographics were similar, except median Sequential Organ Failure Assessment (SOFA) score was higher for the pre-EMS tool group (5 [interquartile range (IQR) 2-8] vs. 2 [IQR 1-4], p < 0.01). Three-hour bundle compliance was significantly higher in the EMS tool group (80% vs. 44.2%, p < 0.01). The pre-EMS tool group had lower median time to lactate (15 [IQR 0-35] vs. 46 min [IQR 34-57], p < 0.001), 30 mL/kg IV fluids (6.5 [IQR 0-38] vs. 46 min [IQR 27.5-72], p < 0.001), and, although not significant, antibiotics (63.5 [IQR 44-92] vs. 72 min [IQR 59.5-112], p = 0.26). CONCLUSION Implementation of an EMS sepsis screening tool resulted in improved 3-hour bundle compliance compared to retrospective control.
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Affiliation(s)
- George Borrelli
- Loyola University Chicago Stritch School of Medicine, 2160 S 1st Ave, Maywood, IL 60153, United States.
| | - Erica Koch
- Loyola University Chicago Stritch School of Medicine, 2160 S 1st Ave, Maywood, IL 60153, United States.
| | - Ethan Sterk
- Department of Emergency Medicine, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, United States.
| | - Shannon Lovett
- Department of Emergency Medicine, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, United States.
| | - Megan A Rech
- Department of Emergency Medicine, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, United States; Department of Pharmacy, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, United States.
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17
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Barriers to Providing Prehospital Care to Ischemic Stroke Patients: Predictors and Impact on Care. Prehosp Disaster Med 2018; 33:501-507. [PMID: 30156180 DOI: 10.1017/s1049023x18000766] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IntroductionIschemic stroke treatment is time-sensitive, and barriers to providing prehospital care encountered by Emergency Medical Services (EMS) providers have been under-studied.Hypothesis/ProblemThis study described barriers to providing prehospital care, identified predictors of these barriers, and assessed the impact of these barriers on EMS on-scene time and administration of tissue plasminogen activator (tPA) in the emergency department (ED). METHODS A retrospective cohort study was performed using the Get With The Guidelines-Stroke (GWTG-S; American Heart Association [AHA]; Dallas, Texas USA) registry at two hospitals to identify ischemic stroke patients arriving by EMS. Variables were abstracted from prehospital and hospital medical records and merged with registry data. Barriers to care were grouped into themes. Logistic regression was used to identify predictors of barriers to care, and bi-variate tests were used to assess differences in EMS on-scene time and the proportion of patients receiving tPA between patients with and without barriers. RESULTS Barriers to providing prehospital care were documented for 15.5% of patients: 29.6% related to access, 26.7% communication, 23.0% extrication and transportation, 20.0% refusal, and 14.1% assessment/management. Non-white and non-black race (OR: 3.69; 95% CI, 1.63-8.36) and living alone (OR: 1.53; 95% CI, 1.05-2.23) were associated with greater odds of barriers to providing care. The EMS on-scene time was ≥15 minutes for 70.4% of patients who had a barrier to care, compared with 49.0% of patients who did not (P<.001). There was no significant difference in the proportion of patients who were administered tPA between those with and without barriers to care (14.1% vs 19.2%; P=.159). CONCLUSIONS Barriers to providing prehospital care were documented for a sizable proportion of ischemic stroke patients, with the majority related to patient access and communication, and occurred more frequently among non-white and non-black patients and those living alone. Although EMS on-scene time was longer for patients with barriers to care, the proportion of patients receiving tPA in the ED did not differ. LiT, CushmanJT, ShahMN, KellyAG, RichDQ, JonesCMC. Barriers to providing prehospital care to ischemic stroke patients: predictors and impact on care. Prehosp Disaster Med. 2018;33(5):501-507.
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18
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Kinsella D, Mosley I, Braitberg G. A Retrospective Study Investigating: Factors associated with mode of arrival and emergency department management for patients with acute stroke. Australas Emerg Care 2018; 21:99-104. [PMID: 30998885 DOI: 10.1016/j.auec.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Presentation by ambulance to the emergency department is critical for stroke patients to receive time dependent treatments. However, little is known of the factors that influence presentation by ambulance. METHODS Retrospective analysis of all patients with an emergency department medical diagnosis of stroke who presented to one of three Victorian emergency departments over a three-year period (2011-2013). A multivariable model was used to investigate demographic characteristics (including triage assessment category, triage identified as stroke, time to CT, and time to diagnosis within the emergency department) as predictors of arrival by ambulance. RESULTS 3548 stroke patients were identified; mean age was 70 years, 53% were males, and 92% had an ischemic stroke. Arrival by ambulance occurred in 71% (n=2509) with arrival by private transport accounting for 29% (n=1039) of patients. Factors significantly associated with arrival by ambulance were older age (p=<0.001), being born in Australia (p=<0.001), and speaking English in the home (p=0.003). Arrival by ambulance was independently associated with rapid stroke care in the emergency department, arrival within 2h from symptom onset, attending an advanced stroke service (access to thrombolysis), triaged for stroke, medical assessment within 25min and referral for CT within 45min. CONCLUSION In this Australian multicenter study, it was identified that patients who arrived by ambulance received faster acute stroke care within the emergency department. Public health education which targets patients who are younger and from a non-English speaking background is needed as these demographics were not associated with timely arrival by ambulance to the emergency department.
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Affiliation(s)
- Danny Kinsella
- Alfred Health, Nursing Education, Australia; Sunshine Hospital, Neurology Department, Australia.
| | - Ian Mosley
- La Trobe University, School of Nursing & Midwifery, College of Science, Health & Engineering, Australia.
| | - George Braitberg
- University of Melbourne, Department of Medicine, Australia; Royal Melbourne Hospital, Emergency Department, Australia.
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19
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Zhang S, Zhang J, Zhang M, Zhong G, Chen Z, Lin L, Lou M. Prehospital Notification Procedure Improves Stroke Outcome by Shortening Onset to Needle Time in Chinese Urban Area. Aging Dis 2018; 9:426-434. [PMID: 29896430 PMCID: PMC5988597 DOI: 10.14336/ad.2017.0601] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/01/2017] [Indexed: 11/16/2022] Open
Abstract
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) can improve clinical outcome in eligible patients with acute ischemic stroke (AIS). However, its efficacy is strongly time-dependent. This study was aimed to examine whether prehospital notification by emergency medical service (EMS) providers could reduce onset to needle time (ONT) and improve neurological outcome in AIS patients who received IVT. We prospectively collected the consecutive clinical and time data of AIS patients who received IVT during one year after the initiation of prehospital notification procedure (PNP). Patients were divided into three groups, including patients that transferred by EMS with and without PNP and other means of transportation (non-EMS). We then compared the effect of EMS with PNP and EMS use only on ONT, and the subsequent neurological outcome. Good outcome was defined as modified Rankin Scale score of 0-2 at 3-months. In 182 patients included in this study, 77 (42.3%) patients were transferred by EMS, of whom 41 (53.2%) patients entered PNP. Compared with non-EMS group, EMS without PNP group greatly shortened the onset to door time (ODT), but EMS with PNP group showed both a significantly shorter DNT (41.3 ± 10.7 min vs 51.9±23.8 min, t=2.583, p=0.012) and ODT (133.2 ± 90.2 min vs 174.8 ± 105.1 min, t=2.228, p=0.027) than non-EMS group. Multivariate analysis showed that the use of EMS with PNP (OR=2.613, p=0.036), but not EMS (OR=1.865, p=0.103), was independently associated with good outcome after adjusting for age and baseline NIHSS score. When adding ONT into the regression model, ONT (OR=0.994, p=0.001), but not EMS with PNP (OR=1.785, p=0.236), was independently associated with good outcome. EMS with PNP, rather than EMS only, improved stroke outcome by shortening ONT. PNP could be a feasible strategy for better stroke care in Chinese urban area.
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Affiliation(s)
- Sheng Zhang
- 1Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jungen Zhang
- 2Hangzhou Emergency Medical Center of Zhejiang Province, Hangzhou, China
| | - Meixia Zhang
- 1Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Genlong Zhong
- 1Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Zhicai Chen
- 1Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Longting Lin
- 3The School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Min Lou
- 1Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Reuter B, Sauer T, Gumbinger C, Bruder I, Preussler S, Hacke W, Hennerici MG, Ringleb PA, Kern R, Stock C. Diurnal Variation of Intravenous Thrombolysis Rates for Acute Ischemic Stroke and Associated Quality Performance Parameters. Front Neurol 2017; 8:341. [PMID: 28785239 PMCID: PMC5519519 DOI: 10.3389/fneur.2017.00341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/29/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction Based on data from the Baden-Wuerttemberg stroke registry, we aimed to explore the diurnal variation of acute ischemic stroke (IS) care delivery. Materials and methods 92,530 IS patients were included, of whom 37,471 (40%) presented within an onset-to-door time ≤4.5 h. Daytime was stratified in 3-h time intervals and working vs. non-working hours. Stroke onset and hospital admission time, rate of door-to-neurological examination time ≤30 min, onset-/door-to-imaging time IV thrombolysis (IVT) rates, and onset-/door-to-needle time were determined. Multivariable regression models were used stratified by stroke onset and hospital admission time to assess the relationship between IVT rates, quality performance parameters, and daytime. The time interval 0:00 h to 3:00 h and working hours, respectively, were taken as reference. Results The IVT rate of the whole study population was strongly associated with the sleep–wake cycle. In patients presenting within the 4.5-h time window and potentially eligible for IVT stratification by hospital admission time identified two time intervals with lower IVT rates. First, between 3:01 h and 6:00 h (IVT rate 18%) and likely attributed to in-hospital delays with the lowest diurnal rate of door-to-neurological examination time ≤30 min and the longest door-to-needle time Second, between 6:01 h and 15:00 h (IVT rate 23–25%) compared to the late afternoon and evening hours (IVT rate 27–29%) due to a longer onset-to-imaging time and door-to-imaging time. No evidence for a compromised stroke service during non-working hours was observed. Conclusion The analysis provides evidence that acute IS care is subject to diurnal variation which may affect stroke outcome. An optimization of IS care aiming at constantly high IVT rates over the course of the day therefore appears desirable.
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Affiliation(s)
- Björn Reuter
- Department of Neurology and Geriatrics, Helios Klinik Müllheim, Müllheim, Germany.,Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Tamara Sauer
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Heidelberg, Germany
| | | | - Ingo Bruder
- Office for Quality Assurance in Hospitals (GeQiK), Baden-Wuerttembergische Hospital Association, Stuttgart, Germany
| | - Stella Preussler
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Werner Hacke
- Department of Neurology, Heidelberg University, Heidelberg, Germany
| | - Michael G Hennerici
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Heidelberg, Germany
| | - Peter A Ringleb
- Department of Neurology, Heidelberg University, Heidelberg, Germany
| | - Rolf Kern
- Department of Neurology, Klinikum Kempten, Kempten, Germany
| | - Christian Stock
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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21
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Szentes T, Kovács L, Óváry C. New hospital structure in the twenty-first century: the position of level III (tertiary) neurological and stroke care in a changing healthcare system. SPRINGERPLUS 2016; 5:2039. [PMID: 27995016 PMCID: PMC5127917 DOI: 10.1186/s40064-016-3710-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 11/21/2016] [Indexed: 11/10/2022]
Abstract
AIM The determination of the necessary capacity and number of neurology wards of level III progressivity that can be defined in the system of criteria detailed in this article and which possess optimal operating conditions in Hungarian terms. METHODS We used the National Health Insurance Company's database to calculate case numbers and capacity for different levels of neurological and stroke care. We also revised the allocation of advanced diagnostic and therapeutic technologies, and proposed changes, based on health insurance data. We also discussed these propositions with clinical experts to test their viability. RESULTS We determined the adequate number of organisational units capable of providing special neurological healthcare services on the basis of the basic data of the Hungarian healthcare system, specifying this number as 6 instead of the current 11. CONCLUSIONS In our study, we have identified significant bias in the nationwide level of neurological and stroke care organisation, which needs revised allocation of healthcare resources. Naturally, this can only be carried out through the restructuring of the emergency care system and the expansion of pre-hospital care.
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Affiliation(s)
- Tamás Szentes
- National Healthcare Service Center, Budapest, Hungary
- National Public Health and Medical Officer Service, Budapest, Hungary
- Department of Public Health, Faculty of Medicine,, Semmelweis University, Budapest, Hungary
- ÁNTSZ Országos Tisztifőorvosi Hivatal, Albert Flórián út 2, 1097 Budapest, Hungary
| | | | - Csaba Óváry
- National Institute of Clinical Neurosciences, Budapest, Hungary
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22
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Williams O, Leighton-Herrmann E, DeSorbo A, Eimicke J, Abel-Bey A, Valdez L, Noble J, Gordillo M, Ravenell J, Ramirez M, Teresi JA, Jean-Louis G, Ogedegbe G. Effect of two 12-minute culturally targeted films on intent to call 911 for stroke. Neurology 2016; 86:1992-5. [PMID: 27164682 DOI: 10.1212/wnl.0000000000002703] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/22/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We assessed the behavioral effect of two 12-minute culturally targeted stroke films on immediately calling 911 for suspected stroke among black and Hispanic participants using a quasi-experimental pretest-posttest design. METHODS We enrolled 102 adult churchgoers (60 black and 42 Hispanic) into a single viewing of one of the 2 stroke films-a Gospel musical (English) or Telenovela (Spanish). We measured intent to immediately call 911 using the validated 28-item Stroke Action Test in English and Spanish, along with related variables, before and immediately after the intervention. Data were analyzed using repeated-measures analysis of variance. RESULTS An increase in intent to call 911 was seen immediately following the single viewing. Higher self-efficacy for calling 911 was associated with intent to call 911 among Hispanic but not black participants. A composite measure of barriers to calling 911 was not associated with intent to call 911 in either group. A significant association was found between higher stroke symptom knowledge and intent to call 911 at baseline, but not immediately following the intervention. No sex associations were found; however, being older was associated with greater intent to call 911. The majority of participants would strongly recommend the films to others. One participant appropriately called 911 for a real-life stroke event. CONCLUSIONS Narrative communication in the form of tailored short films may improve intent to call 911 for stroke among the black and Hispanic population.
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Affiliation(s)
- Olajide Williams
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Ellyn Leighton-Herrmann
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York.
| | - Alexandra DeSorbo
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Joseph Eimicke
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Amparo Abel-Bey
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Lenfis Valdez
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - James Noble
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Madeleine Gordillo
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Joseph Ravenell
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Mildred Ramirez
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Jeanne A Teresi
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Girardin Jean-Louis
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Gbenga Ogedegbe
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
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23
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Prehospital management and identification of sepsis by emergency medical services: a systematic review. Emerg Med J 2016; 33:408-13. [DOI: 10.1136/emermed-2015-205261] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 01/17/2016] [Indexed: 02/05/2023]
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24
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Yin X, Yang T, Gong Y, Zhou Y, Li W, Song X, Wang M, Hu B, Lu Z. Determinants of Emergency Medical Services Utilization Among Acute Ischemic Stroke Patients in Hubei Province in China. Stroke 2016; 47:891-4. [PMID: 26768208 DOI: 10.1161/strokeaha.115.011877] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 12/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Emergency medical services (EMS) can effectively shorten the prehospital delay for patients with acute ischemic stroke. This study aimed to investigate EMS utilization and its associated factors in patients with acute ischemic stroke in China. METHODS A cross-sectional study was conducted from October 1, 2014, to January 31, 2015, which included 2096 patients admitted for acute ischemic stroke from 66 hospitals in Hubei province in China. A multivariable stepwise logistic regression model was undertaken to identify the factors associated with EMS utilization. RESULTS Of the 2096 participants, only 323 cases (15.4%) used EMS. Those acute ischemic stroke patients who previously used EMS (odds ratio [OR] =9.8), whose National Institutes of Health Stroke Scale score was ≥10 (OR=3.7), who lived in urban communities (OR=2.5), who had sudden onset of symptoms (OR=2.4), who experienced their first stroke (OR=1.8), and who recognized initial symptom as stroke (OR=1.4) were more likely to use EMS. Additionally, when acute ischemic stroke patients' stroke symptom were noticed first by others (OR=2.1), rather than by the patients, EMS was more likely to be used. CONCLUSIONS A very low proportion of patients with acute ischemic stroke used the EMS in Hubei province in China. Considerable education programs are required regarding knowledge of potential symptoms and the importance of EMS for stroke.
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Affiliation(s)
- Xiaoxv Yin
- From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.)
| | - Tingting Yang
- From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.)
| | - Yanhong Gong
- From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.)
| | - Yanfeng Zhou
- From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.)
| | - Wenzhen Li
- From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.)
| | - Xingyue Song
- From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.)
| | - Mengdie Wang
- From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.)
| | - Bo Hu
- From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.).
| | - Zuxun Lu
- From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.).
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25
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Affiliation(s)
- A H V Schapira
- Department of Clinical Neurosciences, UCL Institute of Neurology, London, UK.
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26
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André C. Stroke treatment: metrics and processes. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:474-475. [PMID: 26083880 DOI: 10.1590/0004-282x20150090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/06/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Charles André
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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27
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Abstract
There has been a tremendous evolution in the stroke systems of care in the USA. Public awareness, prehospital care, and in-hospital protocols have never been so effectively connected. However, given the critical role of time to effective reperfusion in the setting of acute ischemic stroke, it is vital and timely to implement strategies to further streamline emergency stroke care. This article reviews the most current standards and guidelines related to the flow of stroke care in the prehospital and emergency settings.
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Affiliation(s)
- Keith G DeSousa
- Department of Neurology, University of Miami Miller School of Medicine, 1120 NW 14th St, CRB 13th Floor, Miami, FL, 33136, USA,
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