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Does Emergency Medical Services Transportation Mitigate Post-stroke Discharge Disability? A Prospective Observational

Sudha Xirasagar1, Yuqi Wu2, Khosrow Heidari3

  • 1Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA. sxirasagar@sc.edu.

Journal of General Internal Medicine
|September 2, 2020
PubMed
Summary
This summary is machine-generated.

Emergency medical services (EMS) transport for acute ischemic stroke (AIS) patients is linked to better outcomes, including faster neuroimaging and higher alteplase use. This suggests EMS may reduce long-term disability.

Keywords:
24-h disability improvementacute ischemic strokedischarge disability outcomeemergency medical services use

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Public Health

Background:

  • The impact of emergency medical services (EMS) transport on disability outcomes for acute ischemic stroke (AIS) patients remains unclear.
  • Investigating the association between hospital arrival mode and patient outcomes is crucial for stroke care optimization.

Purpose of the Study:

  • To assess the association between hospital arrival by EMS versus other transport methods and in-hospital and discharge disability outcomes in AIS patients.
  • To adjust for stroke severity when examining the relationship between transport mode and disability.

Main Methods:

  • A prospective observational study was conducted with AIS patients discharged between April 2016 and October 2017.
  • Key outcome measures included National Institutes of Health Stroke Scale (NIHSS) change, 24-hour NIHSS improvement, door to neuroimaging (DTI) time, and IV alteplase receipt, analyzed across stroke severity groups.

Main Results:

  • EMS arrival was associated with significantly shorter DTI times and increased likelihood of alteplase administration.
  • Patients arriving via EMS showed greater NIHSS improvement at 24 hours and discharge, particularly in moderate and severe stroke groups.
  • Alteplase recipients consistently demonstrated better discharge NIHSS improvement.

Conclusions:

  • EMS transport appears to be associated with improved acute stroke care processes and better short-term functional outcomes.
  • Findings support the potential role of EMS in mitigating post-stroke disability.
  • Integrating stroke education into primary care for at-risk individuals is recommended to minimize disability.