title: Use of emergency medical transport and impact on time to care in patients with ischaemic stroke.
abstract: BACKGROUND
  According to numerous studies, using emergency medical services (EMS) to transport stroke patients to hospitals decreases diagnostic and treatment delays.
  
  
  OBJECTIVE
  To determine the frequency of use of EMS by stroke patients in Bizkaia (Spain), analyse the factors associated with using EMS, and study the impact of EMS on time to care.
  
  
  METHODS
  We gathered data from 545 patients hospitalised for acute ischaemic stroke and recruited consecutively. Data were obtained from the patients' medical histories and interviews with the patients themselves or their companions. We studied the following variables: previous health status, stroke symptoms and severity (NIHSS), type of transport, and time to medical care. Univariate and multivariate analyses were performed to identify factors associated with use of EMS and care delays.
  
  
  RESULTS
  Patients transported to hospital by the EMS accounted for 47.2% of the total. Greater stroke severity, arriving at the hospital at night, and poor functional status at baseline were found to be independently associated with use of EMS. Use of EMS was linked to earlier arrival at the hospital. Door-to-imaging times were shorter in the EMS group; however, this association disappeared after adjusting for stroke severity. Revascularisation was more frequent among patients transported by the EMS.
  
  
  CONCLUSIONS
  EMS transport was associated with shorter prehospital delays. Effective health education programmes should be developed to promote EMS transport for patients with stroke symptoms. In-hospital stroke management should also be improved to reduce time to medical care.
authors.affiliation: Delegación Territorial de Bizkaia, Departamento de Salud del Gobierno Vasco, Bilbao, Bizkaia, España. Electronic address: aolascoaga@euskadi.eus.
authors.forename: A
authors.initials: A
authors.lastname: Olascoaga Arrate
authors.affiliation: Servicio de Neurología, Hospital Universitario Basurto, Osakidetza, Bilbao, Bizkaia, España.
authors.forename: M M
authors.initials: MM
authors.lastname: Freijo Guerrero
authors.affiliation: Servicio de Neurología, Hospital Universitario Cruces, Osakidetza, Barakaldo, Bizkaia, España.
authors.forename: C
authors.initials: C
authors.lastname: Fernández Maiztegi
authors.affiliation: Servicio de Neurología, Hospital Galdakao-Usansolo, Osakidetza, Galdakao, Bizkaia, España.
authors.forename: I
authors.initials: I
authors.lastname: Azkune Calle
authors.affiliation: Servicio de Medicina Interna, Servicio de Urgencias, Hospital San Eloy, Osakidetza, Barakaldo, Bizkaia, España.
authors.forename: R
authors.initials: R
authors.lastname: Silvariño Fernández
authors.affiliation: Servicio de Medicina Interna, Servicio de Urgencias, Hospital San Eloy, Osakidetza, Barakaldo, Bizkaia, España.
authors.forename: M
authors.initials: M
authors.lastname: Fernández Rodríguez
authors.affiliation: Emergencias de Osakidetza, Servicio Vasco de Salud, Bilbao, Bizkaia, España.
authors.forename: P
authors.initials: P
authors.lastname: Vazquez Naveira
authors.affiliation: Delegación Territorial de Bizkaia, Departamento de Salud del Gobierno Vasco, Bilbao, Bizkaia, España.
authors.forename: A
authors.initials: A
authors.lastname: Anievas Elena
authors.affiliation: Delegación Territorial de Bizkaia, Departamento de Salud del Gobierno Vasco, Bilbao, Bizkaia, España.
authors.forename: I
authors.initials: I
authors.lastname: Iturraspe González
authors.affiliation: Delegación Territorial de Bizkaia, Departamento de Salud del Gobierno Vasco, Bilbao, Bizkaia, España.
authors.forename: Y
authors.initials: Y
authors.lastname: Pérez Díez
authors.affiliation: Delegación Territorial de Bizkaia, Departamento de Salud del Gobierno Vasco, Bilbao, Bizkaia, España.
authors.forename: R
authors.initials: R
authors.lastname: Ruiz Fernández
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000628:therapy*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013030:Spain; D020521:Stroke / Q000628:therapy*; D061665:Time-to-Treatment; D014187:Transportation of Patients / Q000706:statistics & numerical data*
keywords: Atención al ictus; Code stroke; Código ictus; Demora intrahospitalaria; Emergency medical services; Ictus; In-hospital delay; Servicios de emergencias médicas; Stroke; Stroke management; Stroke symptoms; Síntomas de ictus