Agreement between ambulance and hospital records for information promoting urgent stroke treatment decisions.
OBJECTIVE
Rapid decision-making during acute stroke care can improve outcomes. We wished to assess whether crucial information to facilitate decisions is routinely collected by emergency practitioners before hospital admission.


METHODS
We examined whether ambulance records contained information relevant to a thrombolysis treatment decision for consecutive stroke admissions to three emergency departments in England between 14 May 2012 and 10 June 2013.


RESULTS
In all, 424 of 544 (78%) records included a paramedic diagnosis of stroke. Twice as many hospital records contained a symptom onset time/last known to be well time, but there was 82% agreement within 1 h when a prehospital time was also recorded. This was more likely for younger patients. Documentation of medication history was infrequent (12%), particularly for anticoagulant status (6%). When compared with hospital documentation, paramedics recorded a history of diabetes for 38/49 (78%), previous stroke 44/69 (64%), hypertension 71/140 (51%) and atrial fibrillation 19/64 (30%).


CONCLUSIONS
In a retrospective cohort of stroke patients admitted by emergency ambulance, standard practice did not consistently result in prehospital documentation of information that could promote rapid treatment decisions. Training emergency practitioners and/or providing clinical protocols could facilitate early stroke treatment decisions, but prehospital information availability is likely to be a limiting factor.
aNorthumbria Healthcare NHS Foundation Trust, Ashington bInstitute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK.
Matthew P
MP
Rudd
Alexander J
AJ
Martin
Anne
A
Harrison
Christopher I
CI
Price
D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003657:Decision Making; D004282:Documentation; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006753:Hospital Records / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D006113:United Kingdom