Prehospital identification of stroke--room for improvement

Rapid recognition of stroke is important because it allows early brain imaging and management such as thrombolytic therapy. We evaluated the identification of the diagnosis acute cerebrovascular incident in a physician-based prehospital emergency medical system.

From the Copenhagen Mobile Emergency Care Unit (MECU) register we identified patients classified as having an acute cerebrovascular incident through a 2-year period. We subsequently searched the hospital registration system and compared the consistency between the primary hospital discharge diagnosis and the MECU diagnosis made on referral. Our primary aim was to calculate the proportion of admitted patients with a hospital discharge diagnosis from the category 'acute cerebrovascular incident.'

In total, 583 patients were included in our study. In 25 patients, no hospital discharge diagnosis could be found. Of the remaining 558 patients, a hospital discharge diagnosis of cerebrovascular incident was made for 168 (30.1%) patients. Other cerebral disease was found in 171 (30.7%), systemic disease in 52 (9.3%), and other diagnoses in 167 (29.9%).

We found a low accuracy of the clinical diagnosis acute cerebrovascular incident in the prehospital setting with room and need for improvement in order to allow appropriate and expeditious referral for thrombolytic therapy.