Prehospital transport time intervals for acute stroke patients.
BACKGROUND
Recognizing factors that cause prehospital stroke delays may improve time of presentation to the Emergency Department (ED) and allow earlier treatment of acute stroke patients.


OBJECTIVE
To determine the impact of stroke recognition by emergency medical dispatchers (EMD) and paramedics (PM) on ED arrival time in a large urban Emergency Medical Services system.


METHODS
Retrospective study of patients aged 18 years or more identified as having acute stroke by EMD, PM, or stroke neurologists from January 1, 2005 to December 31, 2005. Data were acquired from computer-assisted dispatch records, paramedic assessments, ICD-9 (International Classification of Diseases, 9(th) Revision) databases, and a hospital stroke registry. Paramedic time to scene, scene time, and total run time were computed for patients with final hospital diagnosis of stroke and grouped into missed strokes and identified strokes by EMD and PM. Time intervals were compared between missed and identified strokes as well as between incidents where EMD and PM agreed or disagreed.


RESULTS
A total of 1067 patients were eligible for the study; 22 were excluded for missing data. For true strokes, EMD and PM were in agreement 27.3% of the time. The median RT was 2.5 min shorter when there was agreement between the providers than when there was disagreement (36.5 min; interquartile range [IQR] 30-43 vs. 39 min.; IQR 33-45, respectively).


CONCLUSIONS
Prehospital scene time and run times for acute strokes are less when there is diagnostic concordance between dispatchers and paramedics. Time intervals did not differ between missed and recognized strokes.
Ramanujam
Prasanthi
P
University of California, San Francisco Medical Center, San Francisco, CA, USA.
Castillo
Edward
E
Patel
Ekta
E
Vilke
Gary
G
Wilson
Michael P
MP
Dunford
James V
JV
D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis*; D013997:Time Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data*