title: Stroke-Unit and emergency medical service: a 48-month experience in northern Italy.
abstract: Since the therapeutic window for acute ischaemic stroke is very short, early arrival at emergency care rooms is mandatory. Emergency medical service (EMS), assuring fast patients transportations, plays a fundamental role in the management of stroke. We have prospectively analysed the utilisation of EMS in the management of stroke patients in a countryside area of northern Italy. Among patients presenting with an acute stroke during the period January 2007-December 2010, those with an ascertained time of onset and documented ongoing brain ischaemia at neuroimaging were included in the study. For all of those patients, the personal data, means of arrival, nature of stroke, whether first stroke or recurrence, severity of stroke and the in-hospital outcome were recorded. Of 1,188 patients hospitalised with a definite diagnosis of stroke, 757 patients were included in the study. Of those, 285 patients (37.6 %) were transported by EMS. EMS allowed earlier admissions (75 % within 3 h of stroke onset), but also transportation of patients of an older age (75 vs. 71 years, p < 0.001), and with more severe strokes (62 % of total anterior circulation infarctions). Our study confirms that EMS is essential in delivering the earliest therapy to patients with acute cerebral infarction living in an extra-urban area of northern Italy. However, work is needed in optimising EMS, since transported patients are often not prone to therapy.
authors.affiliation: Neurological and Emergency Care Units, Policlinico San Marco, Osio Sotto, Bergamo, Italy. claffra@tin.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Camerlingo
authors.forename: Bruno Mario
authors.initials: BM
authors.lastname: Cesana
authors.forename: Veaceslav
authors.initials: V
authors.lastname: Tudose
authors.forename: Giovanni
authors.initials: G
authors.lastname: Simoncini
authors.forename: Oliviero
authors.initials: O
authors.lastname: Valoti
authors.forename: Emilio
authors.initials: E
authors.lastname: Pozzi
authors.forename: Augusto
authors.initials: A
authors.lastname: Zaninelli
authors.forename: Carlo
authors.initials: C
authors.lastname: Ferrarese
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000451:nursing; D013997:Time Factors; D014187:Transportation of Patients