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Prehospital path in acute stroke.

Kashif Waqar Faiz1, Antje Sundseth2, Bente Thommessen2

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Patients with acute stroke contacting emergency services directly experienced shorter delays. Those contacting general practitioners or out-of-hours services faced unnecessary delays, highlighting a need for improved primary care training in stroke management.

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Public Health

Background:

  • Acute stroke patients often miss thrombolytic therapy due to treatment time windows and prehospital delays.
  • Understanding prehospital pathways is crucial for improving acute stroke care.
  • Differentiating patient contact with Emergency Medical Communication Centres (EMCC) versus general practitioners (GP) or Out-of-Hours (OOH) services is key.

Purpose of the Study:

  • To delineate the prehospital journey of acute stroke patients.
  • To identify factors distinguishing patients who contact EMCC versus primary care (GP/OOH).

Main Methods:

  • Retrospective study of 299 acute cerebral infarction and intracerebral haemorrhage patients.
  • Data collected on prehospital path, including delay and medical contacts, from April 2009 to April 2010.
  • Comparison of patient characteristics and prehospital pathways based on initial medical contact.

Main Results:

  • 63.9% of acute stroke patients called EMCC, with 93.7% receiving direct ambulance transport to hospital.
  • Patients contacting GP/OOH services (36.1%) experienced significantly longer patient delay and milder neurological deficits.
  • 60.7% of GP/OOH contacts were advised to attend in person, causing unnecessary delays.

Conclusions:

  • Direct contact with EMCC facilitates faster hospital admission for acute stroke patients.
  • Primary care providers (GP/OOH) advising in-person visits for suspected stroke leads to significant, avoidable delays.
  • Enhanced training for primary care professionals on acute stroke recognition and management is urgently needed.