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Published on: March 21, 2019
Patient characteristics affecting stroke identification by emergency medical service providers in Brooklyn, New York
Mohit Sharma1, Elizabeth Helzner2, Richard Sinert3
1Department of Community Medicine, Government Medical College and Guru Nanak Dev Hospital, Amritsar, 143001, India. mohitsharma.dr@gmail.com.
Insights
Emergency Medical Services (EMS) correctly identified 58.7% of stroke cases, with overcalled strokes occurring in patients with a history of seizures. Key predictors for accurate stroke diagnosis include altered mental status and vital signs.
Area of Science:
- Neurology
- Emergency Medicine
- Public Health
Background:
- Early stroke identification in the prehospital setting is critical due to time-sensitive treatments like thrombolysis and clot extraction.
- Accurate prehospital stroke diagnosis by emergency medical services (EMS) is essential for timely patient management.
Purpose of the Study:
- To identify patient characteristics influencing prehospital stroke diagnosis by Long Island College Hospital (LICH) EMS.
- To evaluate the accuracy of LICH EMS in identifying stroke patients.
Main Methods:
- Retrospective study of 10,384 patients transported by LICH EMS between January 1, 2010, and December 31, 2011.
- Comparison of prehospital care report diagnoses with the Get With The Guidelines (GWTG) database for cerebrovascular diagnoses.
- Age-adjusted logistic regression analysis to determine predictors of accurate or overcalled stroke diagnoses.
Main Results:
- LICH EMS correctly identified 44 out of 75 confirmed stroke cases (sensitivity 58.7%), with a specificity of 99.5%.
- Overcalling stroke occurred in 51 patients, particularly those with a history of seizures or past medical history.
- Predictors for true stroke diagnosis included dispatcher-designated altered mental status, stroke, unconsciousness, and higher prehospital blood pressure quartiles.
Conclusions:
- Prehospital stroke identification by EMS has moderate sensitivity, highlighting a significant rate of missed diagnoses.
- Patient history, dispatcher-provided information, and prehospital vital signs are associated with accurate stroke diagnosis.
- Further improvements in EMS stroke recognition are needed, especially for patients with non-specific symptoms or pre-existing conditions.
Abstract:
Early identification of stroke should begin in the prehospital phase because the benefits of thrombolysis and clot extraction are time dependent. This study aims to identify patient characteristics that affect prehospital identification of stroke by Long Island college hospital (LICH) emergency medical services (EMS). All suspected strokes brought to LICH by LICH ambulances from January 1, 2010 to December 31, 2011 were included in the study. We compared prehospital care report-based diagnosis against the get with the guidelines (GWTG) database. Age-adjusted logistic regression models were used to study that the effect of individual patient characteristics have on EMS providers' diagnosis. Included in the study were 10,384 patients with mean age 43.9 years. Of whom, 75 had a GWTG cerebrovascular diagnosis: 53 were ischemic strokes, 7 transient ischemic attacks, 3 subarachnoid hemorrhage, and 12 intercerebral bleeds. LICH EMS correctly identified 44 of 75 GWTG strokes. Fifty-one patients were overcalled as stroke by the EMS. Overall EMS sensitivity was 58.7 % and specificity was 99.5 %. Dispatcher call type of altered mental status, stroke, unconsciousness, and increasing prehospital blood pressure quartile were found to be significantly predictive of a true stroke diagnosis. Patients with a past medical history and EMS providers' impression of seizures were more likely to be overcalled as a stroke in the field. More than a third of actual stroke patients were missed in the field in our study. Our results show that the patients' past medical history, dispatcher collected information and prehospital vital sign measurements are associated with a true diagnosis of stroke.
