title: Relationship between time from ambulance call to arrival at emergency center and level of consciousness at admission in severe stroke patients.
abstract: BACKGROUND
  Timely access to acute medical treatment can be critical for patients suffering from severe stroke. Little information is available about the impact of prehospital delays on the clinical conditions of stroke patients, but it is possible that prehospital delays lead to neurological deterioration. The aim of this study was to examine the impact of prehospital delays related to emergency medical services on the level of consciousness at admission in patients with severe stroke.
  
  
  METHODS
  This retrospective study assessed 712 consecutive patients diagnosed with cerebrovascular diseases who were admitted to an intensive care unit in Tokyo, Japan, from April 1998 through March 2008. Data, including the time from the call to the ambulance service to the arrival of the ambulance at the patient location (on-scene), and the time from the arrival of the ambulance on-scene to its arrival at the emergency center were obtained. The following demographic and clinical information also were obtained from medical records: sex, age, and Glasgow Coma Scale (GCS) score at admission.
  
  
  RESULTS
  The mean time from ambulance call to arrival on-scene was 7 (SD=3) minutes, and the mean time from ambulance call to arrival at the center was 37 (SD=8) minutes. A logistic regression model for predicting GCS scores of 3 and 4 at admission was produced. After adjusting for sex, age, and time from arrival on-scene to arrival at the center, a longer call-to-on-scene time was significantly associated with poor GCS scores (OR = 1.056/min; 95% confidence interval, [CI] = 1.008-1.107). After adjusting for sex and age, a longer call-to-arrival at the center time also was significantly associated with poor GCS scores (OR = 1.020; 95% CI = 1.002-1.038).
  
  
  CONCLUSIONS
  Prehospital delays were significantly associated with decreased levels of consciousness at admission in patients suffering from a stroke. As level of consciousness is the strongest predictor of outcome, reducing prehospital delays may be necessary to improve the outcomes in patients with severe stroke.
authors.affiliation: Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan. ns-waki@med.teikyo-u.ac.jp
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ohwaki
authors.forename: Takehiro
authors.initials: T
authors.lastname: Watanabe
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shinohara
authors.forename: Tadayoshi
authors.initials: T
authors.lastname: Nakagomi
authors.forename: Eiji
authors.initials: E
authors.lastname: Yano
mesh_terms: D000552:Ambulances / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D015600:Glasgow Coma Scale / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; D011379:Prognosis; D012189:Retrospective Studies; D020521:Stroke / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D013997:Time Factors; D014041:Tokyo