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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
Summary
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.
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.
