title: Patterns of emergency medical services use and its association with timely stroke treatment: findings from Get With the Guidelines-Stroke.
abstract: BACKGROUND
  Prior studies found that only about half of stroke patients arrived at hospitals via emergency medical services (EMSs), yet since then, there have been efforts to increase public awareness that time is brain. Using contemporary Get With the Guidelines-Stroke data, we assessed nationwide EMS use by stroke patients.
  
  
  RESULTS
  We analyzed data from 204 591 patients with ischemic and hemorrhagic stroke admitted to 1563 Get With the Guidelines-Stroke participating hospitals with data on National Institute of Health Stroke Score and insurance status. Hospital arrival by EMSs was observed in 63.7% of patients. Older patients, those with Medicaid and Medicare insurance, and those with severe stroke were more likely to activate EMSs. In contrast, minority race and ethnicity and living in rural communities were associated with decreased odds of EMS use. EMS transport was independently associated with earlier arrival (onset-to-door time, ≤3 hours; adjusted odds ratio, 2.00; 95% confidence interval, 1.93-2.08), prompter evaluation (more patients with door-to-imaging time, ≤25 minutes; odds ratio, 1.89; 95% confidence interval, 1.78-2.00), more rapid treatment (more patients with door-to-needle time, ≤60 minutes; odds ratio, 1.44; 95% confidence interval, 1.28-1.63), and more eligible patients to be treated with tissue-type plasminogen activator if onset is ≤2 hours (67% versus 44%; odds ratio, 1.47; 95% confidence interval, 1.33-1.64).
  
  
  CONCLUSIONS
  Although EMS use is independently associated with more rapid evaluation and treatment of stroke, more than one third of stroke patients fail to use EMSs. Interventions aimed at increasing EMS activation should target populations at risk, particularly younger patients and those of minority race and ethnicity.
authors: Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA. jekundayo@mmc.edu
authors: Olaniyi James
authors: OJ
authors: Ekundayo
authors: Jeffrey L
authors: JL
authors: Saver
authors: Gregg C
authors: GC
authors: Fonarow
authors: Lee H
authors: LH
authors: Schwamm
authors: Ying
authors: Y
authors: Xian
authors: Xin
authors: X
authors: Zhao
authors: Adrian F
authors: AF
authors: Hernandez
authors: Eric D
authors: ED
authors: Peterson
authors: Eric M
authors: EM
authors: Cheng
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004632:Emergency Medical Services / Q000706:statistics & numerical data / Q000639:trends*; D004636:Emergency Service, Hospital / Q000639:trends; D005006:Ethnicity; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000639:trends*; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic / Q000639:trends; D017410:Practice Guidelines as Topic; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D013997:Time Factors; D061665:Time-to-Treatment / Q000639:trends*; D014187:Transportation of Patients / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Get With the Guidelines-Stroke; emergency medical services; stroke