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Published on: January 18, 2018
Prehospital path in acute stroke
Kashif Waqar Faiz1, Antje Sundseth2, Bente Thommessen2
1Nevroklinikken Akershus universitetssykehus og Helsetjenesteforskning Akershus universitetssykehus.
Insights
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.
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.
Background:
Too few patients with acute stroke receive thrombolytic therapy owing to the limited time window for treatment and prehospital delay. The purpose of this study is to describe the prehospital path for patients with acute stroke and, in particular, what distinguishes patients who contact the Emergency Medical Communication Centre (EMCC) from those who contact their general practitioner (GP) or Out-of-hours (OOH) services.
Material And Method:
Patients with acute cerebral infarction and intracerebral haemorrhage admitted to the Stroke Unit, Department of Neurology, Akershus University Hospital, were included. Data on the prehospital path (prehospital delay, medical contacts) were collected over the period 15 April 2009 – 1 April 2010.
Results:
A total of 299 patients were included in the study. The median age was 75 years and 48.5 % were women. In all, 63.9 % of patients with acute stroke called the EMCC, and 93.7 % of these were taken directly to hospital by ambulance. Of those who called the GP’s office or OOH services, 60.7 % were asked to go to the GP’s office or OOH services in person. Patients who called and attended the GP’s office or OOH services had milder neurological deficits (p < 0.001) and longer patient delay (p = 0.018) than those who called the EMCC.
Interpretation:
Six out of ten patients who contacted the primary health care services were asked to go to the GP’s office/OOH services in person, which resulted in unnecessary delay. The findings from this study may indicate a need for specific training of this group of health care professionals in the prompt handling of patients with possible stroke.
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