title: Stroke savvy. The accuracy of EMS-reported last known normal times.
abstract: We collected EMS-reported "last known normal" (LKN) times for patients brought to the ED with suspected acute stroke and calculated the absolute difference between the neurologist-determined and EMS-reported LKN times (deltaLKN). We determined the rate of inappropriate IV tissue plasminogen activator (tPA) use if the EMS-reported times were used instead of the neurologist-determined times. Of 251 patients, mean and median deltaLKN were 28 and 0 minutes, respectively. deltaLKN was < 15 minutes in 91% of the entire group and < 15 minutes in 80% of patients with a diagnosis of stroke. Of patients who received IV tPA, none would've been incorrectly excluded from IV tPA if the EMS LKN time had been used. Conversely, of patients who didn't receive IV tPA, 6% would have been incorrectly included for IV tPA consideration had the EMS time been used. In patients with wake-up stroke symptoms, EMS underestimated LKN times by an average of 208 minutes. All of the potentially incorrectly included patients would've been wake-up strokes.
authors.forename: Keith
authors.initials: K
authors.lastname: Wesley
authors.forename: Karen
authors.initials: K
authors.lastname: Wesley
mesh_terms: D000368:Aged; D003422:Critical Care; D054796:Drug Dosage Calculations; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D004634:Emergency Medical Technicians / Q000193:education; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012015:Reference Standards; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator