title: Determinants of emergency medical services use in a Brazilian population with acute ischemic stroke.
abstract: Emergency medical services (EMS) plays a key role in the recognition and treatment of stroke. This study evaluates the determinants of EMS use in a Brazilian population with acute ischemic stroke. We performed a post hoc analysis of prospectively collected data of consecutive patients admitted to a Brazilian tertiary hospital with acute ischemic stroke. Groups were compared according to their mode of arrival to the hospital: those brought by EMS and those arriving at the hospital by their own means. Among 165 patients evaluated between January and December 2009, 17.6% arrived by EMS and 82.4% arrived by their own means. After multivariate adjustment, individuals with higher National Institutes of Health Stroke Scale score at presentation (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.06-1.23 for each point on the National Institutes of Health Stroke Scale score) were more likely to use EMS, as were those with atrial fibrillation (OR, 5.8; 95% CI, 1.41-24.07) and with lower blood pressure at hospital admission (OR, 0.72; 95% CI, 0.56-0.93 for each mm Hg). Patients brought by EMS had trends toward a lower door-to-neuroimaging time and a higher frequency of thrombolysis therapy (13% in EMS users vs 5% in patients arriving by their own means; P = .10). Our data demonstrate that in a Brazilian population with acute ischemic stroke, the patients with more severe stroke, those with atrial fibrillation, and those with lower blood pressure at hospital presentation were more likely to use EMS. EMS use was associated with trends toward a lower door-to-neuroimaging time and a higher frequency of thrombolysis therapy.
authors.affiliation: Neurology Program and Albert Einstein Stroke Center, Albert Einstein Hospital, São Paulo, Brazil.
authors.forename: Gustavo W
authors.initials: GW
authors.lastname: Kuster
authors.forename: Monique
authors.initials: M
authors.lastname: Bueno Alves
authors.forename: Miguel
authors.initials: M
authors.lastname: Cendoroglo Neto
authors.forename: Gisele Sampaio
authors.initials: GS
authors.lastname: Silva
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D001794:Blood Pressure; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D001938:Brazil / Q000453:epidemiology; D016009:Chi-Square Distribution; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D062606:Tertiary Care Centers; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D013997:Time Factors; D061665:Time-to-Treatment; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014187:Transportation of Patients / Q000706:statistics & numerical data