title: Determinants of Emergency Medical Services Utilization Among Acute Ischemic Stroke Patients in Hubei Province in China.
abstract: OBJECTIVE
  Emergency medical services (EMS) can effectively shorten the prehospital delay for patients with acute ischemic stroke. This study aimed to investigate EMS utilization and its associated factors in patients with acute ischemic stroke in China.
  
  
  METHODS
  A cross-sectional study was conducted from October 1, 2014, to January 31, 2015, which included 2096 patients admitted for acute ischemic stroke from 66 hospitals in Hubei province in China. A multivariable stepwise logistic regression model was undertaken to identify the factors associated with EMS utilization.
  
  
  RESULTS
  Of the 2096 participants, only 323 cases (15.4%) used EMS. Those acute ischemic stroke patients who previously used EMS (odds ratio [OR] =9.8), whose National Institutes of Health Stroke Scale score was ≥10 (OR=3.7), who lived in urban communities (OR=2.5), who had sudden onset of symptoms (OR=2.4), who experienced their first stroke (OR=1.8), and who recognized initial symptom as stroke (OR=1.4) were more likely to use EMS. Additionally, when acute ischemic stroke patients' stroke symptom were noticed first by others (OR=2.1), rather than by the patients, EMS was more likely to be used.
  
  
  CONCLUSIONS
  A very low proportion of patients with acute ischemic stroke used the EMS in Hubei province in China. Considerable education programs are required regarding knowledge of potential symptoms and the importance of EMS for stroke.
authors.affiliation: From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.).
authors.forename: Xiaoxv
authors.initials: X
authors.lastname: Yin
authors.affiliation: From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.).
authors.forename: Tingting
authors.initials: T
authors.lastname: Yang
authors.affiliation: From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.).
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Gong
authors.affiliation: From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.).
authors.forename: Yanfeng
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.).
authors.forename: Wenzhen
authors.initials: W
authors.lastname: Li
authors.affiliation: From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.).
authors.forename: Xingyue
authors.initials: X
authors.lastname: Song
authors.affiliation: From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.).
authors.forename: Mengdie
authors.initials: M
authors.lastname: Wang
authors.affiliation: From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.). zuxunlu@yahoo.com hubo@mail.hust.edu.cn.
authors.forename: Bo
authors.initials: B
authors.lastname: Hu
authors.affiliation: From the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (X.Y., T.Y., Y.G., Y.Z., W.L., X.S., Z.L.), and Department of Neurology, Union Hospital (M.W., B.H.), Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; and The Stroke Quality Control Center of Hubei Province, Wuhan, Hubei, People's Republic of China (B.H.). zuxunlu@yahoo.com hubo@mail.hust.edu.cn.
authors.forename: Zuxun
authors.initials: Z
authors.lastname: Lu
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*
keywords: China; emergency medical services; human; stroke; utilization