title: An observational study of patient characteristics associated with the mode of admission to acute stroke services in North East, England.
abstract: OBJECTIVE
  Effective provision of urgent stroke care relies upon admission to hospital by emergency ambulance and may involve pre-hospital redirection. The proportion and characteristics of patients who do not arrive by emergency ambulance and their impact on service efficiency is unclear. To assist in the planning of regional stroke services we examined the volume, characteristics and prognosis of patients according to the mode of presentation to local services.
  
  
  METHODS
  A prospective regional database of consecutive acute stroke admissions was conducted in North East, England between 01/09/10-30/09/11. Case ascertainment and transport mode were checked against hospital coding and ambulance dispatch databases.
  
  
  RESULTS
  Twelve acute stroke units contributed data for a mean of 10.7 months. 2792/3131 (89%) patients received a diagnosis of stroke within 24 hours of admission: 2002 arrivals by emergency ambulance; 538 by private transport or non-emergency ambulance; 252 unknown mode. Emergency ambulance patients were older (76 vs 69 years), more likely to be from institutional care (10% vs 1%) and experiencing total anterior circulation symptoms (27% vs 6%). Thrombolysis treatment was commoner following emergency admission (11% vs 4%). However patients attending without emergency ambulance had lower inpatient mortality (2% vs 18%), a lower rate of institutionalisation (1% vs 6%) and less need for daily carers (7% vs 16%). 149/155 (96%) of highly dependent patients were admitted by emergency ambulance, but none received thrombolysis.
  
  
  CONCLUSIONS
  Presentations of new stroke without emergency ambulance involvement were not unusual but were associated with a better outcome due to younger age, milder neurological impairment and lower levels of pre-stroke dependency. Most patients with a high level of pre-stroke dependency arrived by emergency ambulance but did not receive thrombolysis. It is important to be aware of easily identifiable demographic groups that differ in their potential to gain from different service configurations.
authors.affiliation: Institute for Ageing and Health (Stroke Research Group), Newcastle University, Newcastle Upon Tyne, United Kingdom.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Price
authors.forename: Victoria
authors.initials: V
authors.lastname: Rae
authors.forename: Jay
authors.initials: J
authors.lastname: Duckett
authors.forename: Ruth
authors.initials: R
authors.lastname: Wood
authors.forename: Joanne
authors.initials: J
authors.lastname: Gray
authors.forename: Peter
authors.initials: P
authors.lastname: McMeekin
authors.forename: Helen
authors.initials: H
authors.lastname: Rodgers
authors.forename: Karen
authors.initials: K
authors.lastname: Portas
authors.forename: Gary A
authors.initials: GA
authors.lastname: Ford
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data