Prehospital notification in acute stroke: a retrospective cohort study

Emergency medical services (EMS) play a key role in identifying stroke patients and transporting them to specialty care centers. We aimed to quantify the time saved in stroke care by EMS prehospital notification.

We performed a retrospective cohort study at a large comprehensive stroke center in a major metropolitan system including patients treated between 2021 and 2022. Inclusion criteria were adult patients transported to the hospital by EMS with a discharge diagnosis of stroke or transient ischemic attack (TIA).

A total of 1053 patients were included, of whom 637 (60.5%) received prehospital notification. Prehospital notification was associated with a median 3-minute adjusted decrease in the door-to-computed-tomography (CT) time (median 18 min, 95% confidence interval [CI] 17-19 vs 21 min, 95% CI 20-22). Among patients who received intravenous thrombolysis (IVT), notification was associated with a faster adjusted time-to-IVT (median 52 min, 95% CI 50-56 vs 63 min, 95% CI 56-69). Of those who underwent endovascular thrombectomy (EVT), notification was associated with faster unadjusted time-to-EVT (median 97 min, 95% CI 93-105 vs 107 min, 95% CI 97-126), but this difference was no longer significant after adjustment.

Prehospital notification is associated with reduced door-to-CT and door-to-IVT times. Prehospital notification in nationwide quality improvement efforts may improve stroke care.