Prehospital neurological deterioration in stroke

Area of Science:

• Neurology
• Emergency Medicine
• Public Health

Background:

• Stroke patients can experience neurological decline before reaching the hospital.
• Identifying factors predicting this prehospital neurological deterioration (PND) is crucial for timely intervention.

Purpose of the Study:

• To evaluate factors associated with prehospital neurological deterioration (PND) in acute stroke patients.
• To analyze the relationship between patient demographics, stroke characteristics, and PND.

Main Methods:

• Retrospective analysis of 1092 acute stroke patients (aged ≥20) from the Greater Cincinnati/Northern Kentucky region (2010).
• PND defined as a decrease of ≥2 points in the Glasgow Coma Scale (GCS) between emergency medical services (EMS) and hospital arrival.
• Data included demographics, medical history, stroke subtype, seizure at onset, time intervals, EMS training level, and vital signs on arrival.

Main Results:

• Prehospital neurological deterioration (PND) occurred in 12% of analyzed stroke patients.
• Higher rates of PND were observed in intracerebral hemorrhage (24%) and subarachnoid hemorrhage (16%) compared to ischemic stroke (9%).
• Multivariable analysis identified Black race, atrial fibrillation, hemorrhagic stroke subtype, and Advanced Life Support (ALS) level of transport as significantly associated with PND.

Conclusions:

• Hemorrhagic stroke and atrial fibrillation are significant factors associated with PND.
• Further investigation is required to predict PND and determine the benefits of specialized transport for deteriorating stroke patients.
• Understanding the link between race and PND, and developing targeted therapies are essential next steps.