Stroke Symptoms Present in Ambulance Records and Prehospital Time Delay-A Retrospective Cohort Study

The outcome of a stroke is highly dependent on time to treatment. Reducing prehospital delay is crucial to increase access to effective stroke treatment.

We aimed to examine how stroke symptoms are recorded and to assess the association between prehospital registration of stroke symptoms and stroke triage and prehospital delay.

We included patients with a final diagnosis of acute stroke, admitted to Nordland Hospital Trust and Helgeland Hospital Trust in Norway from June 2018 to May 2019. Data were extracted from the Emergency Medical Communication Center records, from ambulance reports, and hospital admissions records. Associations between Facial Arm Speech Test (FAST) symptoms and prehospital time were analyzed using linear regression models and the Mann-Whitney U test. Logistic regression was used to assess the association between FAST symptoms and stroke alert.

Of 295 patients, 273 (92.5%) had ≥1 stroke symptom recorded, and 224 (75.9%) had one or more FAST symptoms. Documentation of FAST symptoms in ambulance records was associated with a higher likelihood of activating a stroke alert; odds ratio 6.7 (95% confidence interval: 3.5-13.1) and a significantly shorter prehospital time (17.0 vs. 34.5 min, p = 0.024).

Recording of FAST symptoms in the ambulance was associated with the use of stroke alerts and shorter prehospital time delay. However, 24.1% of the patients with a confirmed stroke did not present with FAST symptoms, highlighting the need to improve prehospital stroke recognition and triage.