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Prehospital Identification of Patients with a Final Hospital Diagnosis of Stroke

Published online by Cambridge University Press:  10 January 2018

Elin Andersson ,
Linda Bohlin ,
Johan Herlitz ,
Annelie J. Sundler ,
Zoltán Fekete  and
Magnus Andersson Hagiwara
Elin Andersson
Affiliation:
Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
Linda Bohlin
Affiliation:
Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
Johan Herlitz
Affiliation:
Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
Annelie J. Sundler
Affiliation:
Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
Zoltán Fekete
Affiliation:
Södra Älvsborg Hospital (SÄS), Department of Neurology, Borås, Sweden
Magnus Andersson Hagiwara*
Affiliation:
Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
*
Correspondence: Magnus Andersson Hagiwara, PhD Centre for Prehospital Research Faculty of Caring Science Work Life and Social Welfare University of Borås SE-501 90 Borås, Sweden E-mail: magnus.hagiwara@hb.se
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Abstract

Introduction

the early phase of stroke, minutes are critical. Since the majority of patients with stroke are transported by the Emergency Medical Service (EMS), the early handling and decision making by the EMS clinician is important.

Problem

The study aim was to evaluate the frequency of a documented suspicion of stroke by the EMS nurse, and to investigate differences in the clinical signs of stroke and clinical assessment in the prehospital setting among patients with regard to if there was a documented suspicion of stroke on EMS arrival or not, in patients with a final hospital diagnosis of stroke.

Methods

The study had a retrospective observational design. Data were collected from reports on patients who were transported by the EMS and had a final diagnosis of stroke at a single hospital in western Sweden (630 beds) in 2015. The data sources were hospital and prehospital medical journals.

Results

In total, 454 patients were included. Among them, the EMS clinician suspected stroke in 52%. The findings and documentation on patients with a suspected stroke differed from the remaining patients as follows:

  1. a) More frequently documented symptoms from the face, legs/arms, and speech;

  2. b) More frequently assessments of neurology, face, arms/legs, speech, and eyes;

  3. c) More frequently addressed the major complaint with regard to time and place of onset, duration, localization, and radiation;

  4. d) Less frequently documented symptoms of headache, vertigo, and nausea; and

  5. e) More frequently had an electrocardiogram (ECG) recorded and plasma glucose sampled.

In addition to the 52% of patients who had a documented initial suspicion of stroke, seven percent of the patients had an initial suspicion of transitory ischemic attack (TIA) by the EMS clinician, and a neurologist was approached in another 10%.

Conclusion

Among 454 patients with a final diagnosis of stroke who were transported by the EMS, an initial suspicion of stroke was not documented in one-half of the cases. These patients differed from those in whom a suspicion of stroke was documented in terms of limited clinical signs of stroke, a less extensive clinical assessment, and fewer clinical investigations.

AnderssonE, BohlinL, HerlitzJ, SundlerAJ, FeketeZ, Andersson HagiwaraM. Prehospital Identification of Patients with a Final Hospital Diagnosis of Stroke. Prehosp Disaster Med. 2018;33(1):63–70.

Keywords

assessmentEMSprehospitalstroke
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 1 , February 2018 , pp. 63 - 70
Copyright
© World Association for Disaster and Emergency Medicine 2018 

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Footnotes

Conflicts of interest: none

References

1. Warburton, E, Alawneh, JA, Clatworthy, PL, Morris, RS. Stroke management. BMJ Clin Evid. 2011;06:201.Google Scholar
2. Riksstroke. Preliminär årsrapport. TIA och akut stroke 2014. http://www.riksstroke.org/ sve/forskning-statistik-och-verksamhetsutveckling/forskning/arsrapporter/2014. Accessed January 1, 2015.Google Scholar
3. Wardlaw, JM, Murray, V, Berge, E, et al. Recombinant tissue plasminogen activator for acute ischemic stroke: an updated systematic review and meta-analysis. Lancet. 2012;379(9834):2364-2372.CrossRefGoogle Scholar
4. Emberson, J, Lees, KR, Lyden, P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischemic stroke: a meta-analysis of individual patient data from randomized trials. Lancet. 2014;384(9958):1929-1935.CrossRefGoogle Scholar
5. Balami, JS, Sutherland, BA, Edmunds, LD, et al. A systematic review and meta-analysis of randomized controlled trials of endovascular thrombectomy compared with best medical treatment for acute ischemic stroke. Int J Stroke. 2015;10(8):1168-1178.CrossRefGoogle ScholarPubMed
6. Appelros, P, Jonsson, F, Åsberg, S, et al. Trends in stroke treatment and outcome between 1995 and 2010: observations from Riks-Stroke, the Swedish stroke register. Cerebrovasc Dis. 2014;37(1):22-29.CrossRefGoogle ScholarPubMed
7. Caceres, JA, Adil, MM, Jadhav, V, et al. Diagnosis of stroke by emergency medical dispatchers and its impact on the prehospital care of patients. J Stroke Cerebrovasc Dis. 2013;22(8):610-614.CrossRefGoogle ScholarPubMed
8. Fassbender, K, Balucani, C, Walter, S, Levine, SR, Haass, A, Grotta, J. Streamlining of prehospital stroke management: the golden hour. Lancet Neurol. 2013;12(12):585-596.CrossRefGoogle ScholarPubMed
9. Bae, HJ, Kim, DH, Yoo, NT, et al. Prehospital notification from the Emergency Medical Service reduces the transfer and intra-hospital processing times for acute stroke patients. J Clinical Neurol. 2010;6(3):138-142.CrossRefGoogle ScholarPubMed
10. Wireklint Sundström, B, Herlitz, J, Hansson, PO, Brink, P. Comparison of the university hospital and county hospitals in western Sweden to identify potential weak links in the early chain of care for acute stroke: results of an observational study. BMJ Open. 2015;5(9).CrossRefGoogle ScholarPubMed
11. Baldereschi, M, Piccardi, B, Di Carlo, A, et al. Relevance of prehospital stroke code activation for acute treatment measures in stroke care: a review. Cerebrovasc Dis. 2012;34(3):182-190.CrossRefGoogle ScholarPubMed
12. Brandler, ES, Sharma, M, McCullough, F, et al. Prehospital stroke identification: factors associated with diagnostic accuracy. J Stroke Cerebrovasc Dis. 2015;24(9):2161-2166.CrossRefGoogle ScholarPubMed
13. De Luca, A, Toni, D, Lauria, L, et al. An emergency clinical pathway for stroke patients--results of a cluster randomized trial. BMC Health Serv Res. 2009;9:14.CrossRefGoogle Scholar
14. Sheppard, JP, Mellor, RM, Greenfield, S, et al. The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study. Emerg Med J. 2015;32(2):93-99.CrossRefGoogle ScholarPubMed
15. Suserud, B-O. A new profession in the pre-hospital care field—the ambulance nurse. Nurs Crit Care. 2005;10:269-271.CrossRefGoogle ScholarPubMed
16. Andersson Hagiwara, M, Suserud, B-O, Andersson-Gare, B, Sjoqvist, B, Henricson, M, Jonsson, A. The effect of a Computerized Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study. BMC Med Inform Decis Mak. 2014;14(1):70.CrossRefGoogle ScholarPubMed
17. Dalton, AL. Advanced Medical Life Support: A Practical Approach to Adult Medical Emergencies. Upper Saddle River, New Jersey USA: Pearson; 2010.Google Scholar
18. Widgren, BR, Jourak, M. Medical Emergency Triage and Treatment System (METTS). A new protocol in primary triage and secondary priority decision in emergency medicine. J Emerg Med. 2011;40(6):623-628.CrossRefGoogle Scholar
19. Moreira, E, Correia, M, Magalhães, R, Silva, MC. Stroke awareness in urban and rural populations from northern Portugal: knowledge and action are independent. Neuroepidemiology. 2011;36(4):265-273.CrossRefGoogle Scholar
20. Persson, M, Fhager, A, Trefn, HD, et al. Microwave-based stroke diagnosis making global prehospital thrombolytic treatment possible. IEEE Trans Biomed Eng. 2014;61(11):2806-2817.CrossRefGoogle Scholar
21. Kaji, AH, Schriger, D, Green, S. Looking through the retrospectoscope: reducing bias in emergency medicine chart review studies. Ann Emerg Med. 2014;64(3):292-298.CrossRefGoogle Scholar
22. Bledsoe, BE, Wasden, C, Johnson, L. Electronic prehospital records are often unavailable for emergency department medical decision making. West J Emerg Med. 2013;14(5):482-488.CrossRefGoogle ScholarPubMed