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Recognition of Stroke by EMS is Associated with Improvement in Emergency Department Quality Measures.
- Source :
- Prehospital Emergency Care; Nov/Dec2016, Vol. 20 Issue 6, p729-736, 8p
- Publication Year :
- 2016
-
Abstract
- Objective:Hospital arrival via Emergency Medical Services (EMS) and EMS prenotification are associated with faster evaluation and treatment of stroke. We sought to determine the impact of diagnostic accuracy by prehospital providers on emergency department quality measures.Methods:A retrospective study was performed of patients presenting via EMS between September 2009 and December 2012 with a discharge diagnosis of transient ischemic attack (TIA), ischemic stroke (IS), or intracerebral hemorrhage (ICH). Hospital and EMS databases were used to determine EMS impression, prehospital and in-hospital time intervals, EMS prenotification, NIH stroke scale (NIHSS), symptom duration, and thrombolysis rate.Results:399 cases were identified: 14.5% TIA, 67.2% IS, and 18.3% ICH. EMS providers correctly recognized 57.6% of cases. Compared to cases missed by EMS, correctly recognized cases had longer median on-scene time (17 vs. 15 min,p= 0.01) but shorter transport times (12 vs. 15 min,p= 0.001). Cases correctly recognized by EMS were associated with shorter door-to-physician time (4 vs. 11 min,p< 0.001) and shorter door-to-CT time (23 vs. 48 min,p< 0.001). These findings were independent of age, NIHSS, symptom duration, and EMS prenotification. Patients with ischemic stroke correctly recognized by EMS were more likely to receive thrombolytic therapy, independent of age, NIHSS, symptom duration both with and without prenotification.Conclusion:Recognition of stroke by EMS providers was independently associated with faster door-to-physician time, faster door-to-CT time, and greater odds of receiving thrombolysis. Quality initiatives to improve EMS recognition of stroke have the potential to improve hospital-based quality of stroke care. [ABSTRACT FROM PUBLISHER]
- Subjects :
- TRANSIENT ischemic attack diagnosis
STROKE diagnosis
CEREBROVASCULAR disease
COMPUTED tomography
EMERGENCY medical services
EMERGENCY medical technicians
EMERGENCY medicine
ETHNIC groups
HOSPITAL emergency services
MEDICAL needs assessment
MEDICAL quality control
RACE
STROKE
DATA analysis
RETROSPECTIVE studies
ELECTRONIC health records
MANN Whitney U Test
KRUSKAL-Wallis Test
NIH Stroke Scale
SYMPTOMS
Subjects
Details
- Language :
- English
- ISSN :
- 10903127
- Volume :
- 20
- Issue :
- 6
- Database :
- Complementary Index
- Journal :
- Prehospital Emergency Care
- Publication Type :
- Academic Journal
- Accession number :
- 119150267
- Full Text :
- https://doi.org/10.1080/10903127.2016.1182602