title: [Concept for allocation of acute stroke patients: evaluation of the quality of diagnosis reached by the emergency medical services of Münster].
abstract: BACKGROUND
  Acute stroke is a time- and expertise-critical emergency. An immediate and correct diagnosis by emergency medical services (EMS) in the prehospital phase and patient transfer to the nearest adequate hospital with a stroke unit is required for early treatment of acute stroke.
  
  
  METHODS
  We evaluated all patients who were admitted by the EMS of Münster to one of the two stroke units in the town between October 2008 and December 2010 with a diagnosis of acute stroke. Furthermore all patients were critically analyzed who were admitted without a diagnosis of acute stroke by the EMS but nonetheless had a stroke and the correct diagnosis was not found until examination in the neurological department.
  
  
  RESULTS
  We analyzed 615 patients who were admitted to the stroke units with the diagnosis of acute stroke. In 561 cases (91%) this diagnosis could be confirmed, but in 54 patients (9%) the diagnosis by the EMS was incorrect. Epileptic seizure was the most frequent false-positive diagnosis in this group of patients (39%; n = 21). Although the acute symptoms were caused by a stroke, the correct diagnosis was not defined by the EMS in 127 patients. This accounted for 18% of all patients admitted to the emergency departments by the EMS where ultimately a stroke was diagnosed. In 24% of these cases (n = 30) the emergency doctor missed the correct diagnosis, which meant 4% of all patients admitted by the EMS, finally diagnosed with an acute stroke. In all other cases in the group with a false-negative diagnosis (76% or 97 patients) an emergency doctor was not involved in the referral by the EMS.
  
  
  CONCLUSIONS
  Emergency medical services should be involved in the establishment of admission programs for acute stroke patients to provide the fastest means of transportation to a stroke unit. Coma, symptoms of posterior cerebral circulation and epileptic seizures cause difficulties in ensuring an immediate and correct diagnosis. Sending an emergency doctor to the scene increases diagnostic certainty which is essential to initiate early treatment.
authors.affiliation: Klinik und Poliklinik für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Deutschland. schillim@uni-muenster.de
authors.forename: M
authors.initials: M
authors.lastname: Schilling
authors.forename: M
authors.initials: M
authors.lastname: Kros
authors.forename: M
authors.initials: M
authors.lastname: Ritter
authors.forename: M
authors.initials: M
authors.lastname: Ohms
authors.forename: W R
authors.initials: WR
authors.lastname: Schäbitz
authors.forename: W
authors.initials: W
authors.lastname: Kusch
authors.forename: E B
authors.initials: EB
authors.lastname: Ringelstein
authors.forename: T P
authors.initials: TP
authors.lastname: Weber
authors.forename: U
authors.initials: U
authors.lastname: Harding
authors.forename: A
authors.initials: A
authors.lastname: Bohn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003951:Diagnostic Errors / Q000517:prevention & control* / Q000706:statistics & numerical data*; D004632:Emergency Medical Services; D005260:Female; D005858:Germany / Q000453:epidemiology; D015276:Health Care Rationing; D006801:Humans; D008297:Male; D015995:Prevalence; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult