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Prehospital Stroke Identification: Factors Associated with Diagnostic Accuracy
Ethan S Brandler1, Mohit Sharma2, Flynn McCullough3
1Department of Emergency Medicine, State University of New York at Stony Brook, Stony Brook, New York; Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, New York.
Summary
Emergency medical services (EMS) missed over a third of stroke cases. Atypical symptoms like dizziness and seizures contributed to misdiagnosis, highlighting the need for improved prehospital stroke identification methods.
Area of Science:
- Emergency medicine
- Neurology
- Public health
Background:
- Misdiagnosis of stroke by emergency medical services (EMS) leads to delayed care.
- Accurate prehospital stroke identification is crucial for timely treatment.
Purpose of the Study:
- To determine the diagnostic accuracy of Fire Department of New York (FDNY) EMS providers for stroke.
- To identify factors contributing to stroke misdiagnosis in the prehospital setting.
Main Methods:
- Comparison of FDNY EMS prehospital care reports with the American Heart Association Get With The Guidelines (GWTG) database.
- Analysis of 72,984 patient transports from January 1, 2010, to December 31, 2011.
- Age-adjusted logistic regression to identify characteristics associated with misdiagnosis.
Main Results:
- FDNY EMS correctly identified 62% of stroke cases; 38% were missed.
- Sensitivity was 62.4%, specificity was 99.6%.
- Atypical presentations (malaise, dizziness, headache) and seizures were associated with missed or incorrect stroke diagnoses.
Conclusions:
- Over one-third of stroke cases were missed by FDNY EMS providers.
- Seizures and atypical symptoms significantly impact prehospital stroke diagnosis accuracy.
- Improved prehospital stroke identification methods are urgently needed.
