title: The role of calling EMS versus using private transportation in improving the management of stroke in France.
abstract: OBJECTIVE
  To compare the time from symptom onset to brain imaging between patients calling emergency medical services (EMS) and those using private means for transportation.
  
  
  METHODS
  We focused on symptom onset-to-brain imaging times of ≤2 hours and ≤3 hours 30 minutes, assuming a one-hour interval between imaging and thrombolysis. Other variables were the patient's age, gender, stroke type, National Institutes of Health Stroke Scale (NIHSS) score, presence of an on-site stroke unit, and period of symptom onset. Univariate analyses and a hierarchical linear regression model were used, as appropriate, and adjusted for these variables.
  
  
  RESULTS
  A total of 1,105 stroke patients (28%) were included in the analyses, 40.6% of them transported by EMS. Patients using EMS were significantly older (72.8 vs. 70.5 years; p = 0.008), they had a higher NIHSS score (8 vs. 6.1; p = 0.0001), fewer were ischemic (85.1% vs. 90.6%; p = 0.005), and more of them reached hospitals with an on-site stroke unit (81.3% vs. 72.9%; p = 0.002). For the EMS-call patients, the median symptom onset-to-brain imaging time was significantly shorter (3 hours 21 minutes vs. 5 hours 57 minutes), and after adjustment, maximum delays of 2 hours and 3 hours 30 minutes were independently associated with EMS call: 28% vs. 18% (p = 0.015) and 66% vs. 45% (p < 0.0001) of patients, respectively, leading to an adjusted odds ratio of 2.77 (95% confidence interval, 2.007-3.828; p < 0.0001) for the threshold of 3 hours 30 minutes.
  
  
  CONCLUSIONS
  The symptom onset-to-brain imaging time was significantly shorter in case of EMS transportation, but most patients did not reach the hospital in time to be eligible for thrombolysis. Efforts are still needed to reduce delays, especially public education and EMS activation. These efforts should be combined with new approaches for the quality management of stroke patients.
authors: INSERM-COMPAQ-HPST Project, Institut de Cancérologie Gustave Roussy, Villejuif, France.
authors: Kristel
authors: K
authors: Gache
authors: Melanie
authors: M
authors: Couralet
authors: Gérard
authors: G
authors: Nitenberg
authors: Henri
authors: H
authors: Leleu
authors: Etienne
authors: E
authors: Minvielle
mesh_terms: D000368:Aged; D000552:Ambulances; D057210:Delayed Diagnosis / Q000517:prevention & control*; D005260:Female; D005602:France; D006801:Humans; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D011787:Quality of Health Care; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy; D013997:Time Factors; D014187:Transportation of Patients / Q000379:methods*