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Wenstrup J, Hestoy BH, Sagar MV, Blomberg SNF, Christensen H, Christensen HC, Kruuse C. Emergency Medical Services dispatcher recognition of stroke: A systematic review. Eur Stroke J 2024; 9:283-294. [PMID: 38174575 PMCID: PMC11318428 DOI: 10.1177/23969873231223339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE Stroke treatments are time-sensitive, and thus early and correct recognition of stroke by Emergency Medical Services is essential for outcomes. This is particularly important with the adaption of mobile stroke units. In this systematic review, we therefore aimed to provide a comprehensive overview of Emergency Medical Services dispatcher recognition of stroke. METHODS The review was registered on PROSPERO and the PRISMA guidelines were applied. We searched PubMed, Embase, and Cochrane Review Library. Screening and data extraction were performed by two observers. Risk of bias was assessed using the QUADAS-2 instrument. FINDINGS Of 1200 papers screened, 24 fulfilled the inclusion criteria. Data on sensitivity was reported in 22 papers and varied from 17.9% to 83.0%. Positive predictive values were reported in 12 papers and ranged from 24.0% to 87.7%. Seven papers reported specificity, which ranged from 20.0% to 99.1%. Six papers reported negative predictive value, ranging from 28.0% to 99.4%. In general, the risk of bias was low. DISCUSSION Stroke recognition by dispatchers varied greatly, but overall many patients with stroke are not recognised, despite the initiatives taken to improve stroke literacy. The available data are of high quality, however Asian, African, and South American populations are underrepresented. CONCLUSION While the data are heterogenous, this review can serve as a reference for future research in emergency medical dispatcher stroke recognition and initiatives to improve prehospital stroke recognition.
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Affiliation(s)
- Jonathan Wenstrup
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Emergency Medical Services, Copenhagen, Denmark
- Emergency Medical Services, Region Zealand, Denmark
| | - Bartal Hofgaard Hestoy
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Malini Vendela Sagar
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | | | - Hanne Christensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Helle Collatz Christensen
- Emergency Medical Services, Region Zealand, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christina Kruuse
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Brain- and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Magriço M, Serôdio M, Ramos JN, Ventura R, Sobral-Pinho A, Marto JP, Viana-Baptista M. Are we missing an opportunity? Prehospital delay in patients with acute ischemic stroke and known atrial fibrillation. Rev Port Cardiol 2024; 43:321-325. [PMID: 38395298 DOI: 10.1016/j.repc.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES The follow-up of patients with atrial fibrillation (AF) presents an opportunity to alert patients and their families on how to recognize and act in the event of stroke. Our aim was to compare stroke recognition-to-door time and prehospital stroke code activation in patients with known AF (KAF) and AF detected after stroke (AFDAS). METHODS We performed a retrospective cohort study of consecutive patients receiving acute recanalization treatment for acute ischemic stroke between January 2016 and August 2022, with AF as a potential stroke cause. Patients were divided into KAF and AFDAS, and stroke recognition-to-door time and prehospital stroke code activation were compared. In the KAF subgroup, we assessed whether the use of preadmission anticoagulation was associated with the studied prehospital parameters. RESULTS We included 438 patients, 290 female (66.2%), mean age 79.3±9.4 years. In total, 238 patients had KAF (54.3%) and 200 (45.7%) had AFDAS. Of those with KAF, 114 (48.1%) were pretreated with anticoagulation. Patients with KAF and AFDAS had no differences in stroke recognition-to-door time (74.0 [55.0-101.0] vs. 78.0 [60.0-112.0] min; p=0.097) or prehospital stroke code activation [148 (64.6%) vs. 128 (65.3%); p=0.965]. In the KAF subgroup, preadmission anticoagulation did not influence stroke recognition-to-door time or mode of hospital admission. CONCLUSION Stroke recognition-to-door time and prehospital stroke code activation were similar between patients with known or newly diagnosed AF. Preadmission anticoagulation treatment also did not affect the studied parameters. Our findings highlight a missed opportunity to promote stroke knowledge in patients followed due to AF.
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Affiliation(s)
- Marta Magriço
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Serôdio
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
| | - João Nuno Ramos
- Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Rita Ventura
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - André Sobral-Pinho
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Chronic Diseases Research Centre (CEDOC), Faculdade de Ciências Médicas|NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Miguel Viana-Baptista
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Chronic Diseases Research Centre (CEDOC), Faculdade de Ciências Médicas|NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
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Lindström V, Romanitan MO, Berglund A, Pirvulescu RA, von Euler M, Bohm K. Callers' Descriptions of Stroke Symptoms during Emergency Calls in Victims Who Have Fallen or Been Found Lying Down: A Qualitative Content Analysis. Healthcare (Basel) 2024; 12:497. [PMID: 38391872 PMCID: PMC10888314 DOI: 10.3390/healthcare12040497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/30/2024] [Accepted: 02/16/2024] [Indexed: 02/24/2024] Open
Abstract
Early identification of stroke symptoms is essential. The rate of stroke identification by call-takers at emergency medical communication centres (EMCCs) varies, and patients who are found in a lying down position are often not identified as having an ongoing stroke. OBJECTIVES this study aimed to explore signs and symptoms of stroke in patients who had fallen or were found in a lying position. DESIGN a retrospective exploratory qualitative study design was used. METHOD a total of 29 emergency calls to EMCCs regarding patients discharged with a stroke diagnosis from a large teaching hospital in Stockholm, Sweden, in January-June 2011, were analysed using qualitative content analysis. RESULTS during the emergency calls, the callers described a sudden change in the patient's health status including signs such as the patient's loss of bodily control, the patient's perception of a change in sensory perception, and the callers' inability to communicate with the patient. CONCLUSIONS The callers' descriptions of stroke in a person found in a lying position are not always as described in assessment protocols describing the onset of a stroke. Instead, the symptom descriptions are much vaguer. Therefore, to increase identification of stroke during emergency calls, there is a need for an increased understanding of how callers describe stroke symptoms and communicate with the call-takers.
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Affiliation(s)
- Veronica Lindström
- Department of Nursing, Umeå University, 90187 Umeå, Sweden;
- Department of Health Promotion, Sophiahemmet University, 11486 Stockholm, Sweden
- The Ambulance Service, Region of Västerbotten, 90189 Umeå, Sweden
| | - Mihaela Oana Romanitan
- Department of Internal Medicine, Södersjukhuset, 11883 Stockholm, Sweden;
- Karolinska Institute’s Stroke Research Network at Södersjukhuset, Department of Clinical Science and Education, 11883 Stockholm, Sweden;
| | - Annika Berglund
- Department of Clinical Neuroscience, Karolinska Institutet, 17177 Solna, Sweden;
| | | | - Mia von Euler
- Department of Neurology, Örebro University Hospital, 70185 Örebro, Sweden;
- School of Medical Sciences, Örebro University, 70182 Örebro, Sweden
| | - Katarina Bohm
- Karolinska Institute’s Stroke Research Network at Södersjukhuset, Department of Clinical Science and Education, 11883 Stockholm, Sweden;
- Department of Emergency Medicine, Södersjukhuset, 11883 Stockholm, Sweden
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Tworek K, Tomaszewska A, Owecka B, Fryska Z, Marcinkowski JT, Owecki M. Non-compliance with medical recommendations results in delayed hospitalization and poorer prognosis in patients with cerebral ischemic stroke in Poland: Non-compliance effects on post-ischemic stroke prognosis. J Stroke Cerebrovasc Dis 2024; 33:107465. [PMID: 37949030 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/06/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES This study aimed to reveal and analyze the causes of delays in reaching the hospital of patients with cerebral ischemic stroke and to assess their clinical picture. MATERIAL AND METHODS The study group included 161 patients with stroke, who reported to the hospital beyond the thrombolytic treatment therapeutic window. The control group consisted of 85 patients recruited consecutively with stroke who received thrombolytic treatment per eligibility criteria. Laboratory and medical imaging tests essential for neurological condition assessment were conducted in the study group. Control group research was based on retrospective analysis of medical records. RESULTS The rate of deaths during hospitalization was lower in the control group (4.7%) compared to the study group (14.9%). In the study group, more patients (16.8%) admitted to non-compliance with medical recommendations than in the control group (5.9%). There were no statistically significant differences in nicotinism and alcohol dependence syndrome frequency between both groups. CONCLUSIONS Based on each group inclusion criteria, a lower mortality rate in the control group indicates a crucial role of the therapeutic window in cerebral stroke treatment. Analysis of reasons for delay points out that efficient prophylaxis is the education of patients with stroke risk factors and their families.
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Affiliation(s)
- Karolina Tworek
- Department of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland
| | - Agata Tomaszewska
- Students Research Circle of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland
| | - Barbara Owecka
- Students Research Circle of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland
| | - Zuzanna Fryska
- Students Research Circle of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland
| | - Jerzy T Marcinkowski
- Department of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland
| | - Maciej Owecki
- Department of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland.
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Tarantini L, Merzou F, Luley M, Rollmann A, Schwindling MP, Lesmeister M, Gläss M, Wollenburg J, Schwindling L, Fassbender K. Perceived performance of activities of daily living by stroke patients: key in decision to call EMS and outcomes. Front Neurol 2023; 14:1241391. [PMID: 37808509 PMCID: PMC10556741 DOI: 10.3389/fneur.2023.1241391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Until recently, public education campaigns aimed at improving help-seeking behavior by acute stroke patients have achieved only limited or even no effects. Better understanding of psychological factors determining help-seeking behavior may be relevant in the design of more effective future campaigns. Methods In this prospective, cross-sectional study, we interviewed 669 acute stroke patients within 72 h after hospital admission. The primary endpoint was the effect of psychological factors on the decision to call emergency medical services (EMS). Secondary endpoints were the effects of such factors on treatment rates and clinical improvement (difference between modified Rankin scale (MRS) scores at admission and at discharge). Results Only 48.7% of the study population called the EMS. Multivariate logistic and linear regression analyses revealed that perception of unimpaired performance of activities of daily living (ADL) was the only psychological factor that predicted EMS use and outcomes. Thus, patients who perceived only minor impairment in performing ADL were less likely to use EMS (odds ratio, 0.54 [95% confidence interval, 0.38-0.76]; p = 0.001), had lower treatment rates, and had less improvement in MRS scores (b = 0.40, p = 0.004). Additional serial mediation analyses involving ischemic stroke patients showed that perception of low impairment in ADL decreased the likelihood of EMS notification, thereby increasing prehospital delays, leading to reduced thrombolysis rates and, finally, to reduced clinical improvement. Conclusion Perception of unimpaired performance of ADL is a crucial barrier to appropriate help-seeking behavior after acute stroke, leading to undertreatment and less improvement in clinical symptoms. Thus, beyond improving the public's knowledge of stroke symptoms, future public education campaigns should focus on the need for calling the EMS in case of stroke symptoms even if daily activities do not seem to be severely impaired.
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Affiliation(s)
- Luca Tarantini
- Experimental Neuropsychology Unit, Department of Psychology, Saarland University, Saarbrücken, Germany
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Fatma Merzou
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Maxine Luley
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Aline Rollmann
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | | | - Martin Lesmeister
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Marietheres Gläss
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Jennifer Wollenburg
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Lenka Schwindling
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Klaus Fassbender
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
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Berg KP, Sørensen VFI, Blomberg SNF, Christensen HC, Kruuse C. Recognition of visual symptoms in stroke: a challenge to patients, bystanders, and Emergency Medical Services. BMC Emerg Med 2023; 23:96. [PMID: 37626329 PMCID: PMC10463357 DOI: 10.1186/s12873-023-00870-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Identification of visual symptoms as a sign of acute stroke can be challenging for both first line healthcare professionals and lay persons. Failed recognition of visual symptoms by medical dispatchers at the Emergency Medical Dispatch Center (EMDC-112) or personnel at the Out-of-Hours Health Service (OOHS) may delay stroke revascularization. We aimed to identify correct system response to visual symptoms in emergency calls. METHODS Phone calls from patient or bystander to the EMDC-112 or OOHS, which included visual symptoms on patients later verified with stroke/Transient ischemic attack (TIA) diagnosis, were analyzed. Data were stratified according to hospitalization within and after 4.5 h from symptom onset. Descriptive and multiple logistic regression analysis were performed. RESULTS Of 517 calls identified, 290 calls fulfilled inclusion criteria. Only 30% of the patients received correct visitation by the medical dispatchers and referral to the hospital by a high-priority ambulance. Correct visitation was associated with early contact (adjusted OR: 2.37, 95% CI: 1.11, 5.03), contact to the EMDC-112 (adjusted OR: 3.18, 95% CI: 1.80, 5.62), and when the medical dispatcher asked additional questions on typical stroke symptoms (adjusted OR: 6.36, 95% CI: 3.01, 13.43). No specific visual symptom was associated with stroke recognition and fast hospitalization. CONCLUSIONS First line healthcare professionals had significant problems in identifying visual symptoms as a sign of acute stroke and eliciting correct response. This highlights an urgent need to improve knowledge of visual symptoms in acute stroke and emphasize correct response to stroke symptoms in general.
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Affiliation(s)
- Kristina Parsberg Berg
- Department of Neurology, Copenhagen University Hospital - Herlev Gentofte, Copenhagen, Denmark
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, 2750, Copenhagen, Denmark
| | - Viktor Frederik Idin Sørensen
- Department of Neurology, Copenhagen University Hospital - Herlev Gentofte, Copenhagen, Denmark
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, 2750, Copenhagen, Denmark
| | | | - Helle Collatz Christensen
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, 2750, Copenhagen, Denmark.
- Danish Clinical Quality Program (RKKP), National Clinical Registries, Copenhagen, Denmark.
- Emergency Medical Services Region Zealand, Naestved, Denmark.
| | - Christina Kruuse
- Department of Neurology, Copenhagen University Hospital - Herlev Gentofte, Copenhagen, Denmark
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Dixon M, Appleton JP, Scutt P, Woodhouse LJ, Haywood LJ, Havard D, Williams J, Siriwardena AN, Bath PM. Time intervals and distances travelled for prehospital ambulance stroke care: data from the randomised-controlled ambulance-based Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2). BMJ Open 2022; 12:e060211. [PMID: 36410799 PMCID: PMC9680177 DOI: 10.1136/bmjopen-2021-060211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Ambulances offer the first opportunity to evaluate hyperacute stroke treatments. In this study, we investigated the conduct of a hyperacute stroke study in the ambulance-based setting with a particular focus on timings and logistics of trial delivery. DESIGN Multicentre prospective, single-blind, parallel group randomised controlled trial. SETTING Eight National Health Service ambulance services in England and Wales; 54 acute stroke centres. PARTICIPANTS Paramedics enrolled 1149 patients assessed as likely to have a stroke, with Face, Arm, Speech and Time score (2 or 3), within 4 hours of symptom onset and systolic blood pressure >120 mm Hg. INTERVENTIONS Paramedics administered randomly assigned active transdermal glyceryl trinitrate or sham. PRIMARY AND SECONDARY OUTCOMES Modified Rankin scale at day 90. This paper focuses on response time intervals, distances travelled and baseline characteristics of patients, compared between ambulance services. RESULTS Paramedics enrolled 1149 patients between September 2015 and May 2018. FINAL DIAGNOSIS intracerebral haemorrhage 13%, ischaemic stroke 52%, transient ischaemic attack 9% and mimic 26%. Timings (min) were (median (25-75 centile)): onset to emergency call 19 (5-64); onset to randomisation 71 (45-116); total time at scene 33 (26-46); depart scene to hospital 15 (10-23); randomisation to hospital 24 (16-34) and onset to hospital 97 (71-141). Ambulances travelled (km) 10 (4-19) from scene to hospital. Timings and distances differed between ambulance service, for example, onset to randomisation (fastest 53 min, slowest 77 min; p<0.001), distance from scene to hospital (least 4 km, most 20 km; p<0.001). CONCLUSION We completed a large prehospital stroke trial involving a simple-to-administer intervention across multiple ambulance services. The time from onset to randomisation and modest distances travelled support the applicability of future large-scale paramedic-delivered ambulance-based stroke trials in urban and rural locations. TRIAL REGISTRATION NUMBER ISRCTN26986053.
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Affiliation(s)
- Mark Dixon
- Division of Mental Health and Clinical Neuroscience, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
- Leicester, Leicestershire & Rutland Division, East Midlands Ambulance Service NHS Trust, Nottingham, UK
| | - Jason P Appleton
- Stroke, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Polly Scutt
- Division of Mental Health and Clinical Neuroscience, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Lisa J Woodhouse
- Division of Mental Health and Clinical Neuroscience, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Lee J Haywood
- Division of Mental Health and Clinical Neuroscience, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Diane Havard
- Division of Mental Health and Clinical Neuroscience, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Julia Williams
- Division of Paramedic Science, School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | | | - Philip M Bath
- Division of Mental Health and Clinical Neuroscience, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
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Stroke Risk Prediction with Machine Learning Techniques. SENSORS 2022; 22:s22134670. [PMID: 35808172 PMCID: PMC9268898 DOI: 10.3390/s22134670] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 01/25/2023]
Abstract
A stroke is caused when blood flow to a part of the brain is stopped abruptly. Without the blood supply, the brain cells gradually die, and disability occurs depending on the area of the brain affected. Early recognition of symptoms can significantly carry valuable information for the prediction of stroke and promoting a healthy life. In this research work, with the aid of machine learning (ML), several models are developed and evaluated to design a robust framework for the long-term risk prediction of stroke occurrence. The main contribution of this study is a stacking method that achieves a high performance that is validated by various metrics, such as AUC, precision, recall, F-measure and accuracy. The experiment results showed that the stacking classification outperforms the other methods, with an AUC of 98.9%, F-measure, precision and recall of 97.4% and an accuracy of 98%.
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Artificially-reconstructed brain images with stroke lesions from non-imaging data: modeling in categorized patients based on lesion occurrence and sparsity. Sci Rep 2022; 12:10116. [PMID: 35710703 PMCID: PMC9203453 DOI: 10.1038/s41598-022-14249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 06/03/2022] [Indexed: 11/08/2022] Open
Abstract
Brain imaging is necessary for understanding disease symptoms, including stroke. However, frequent imaging procedures encounter practical limitations. Estimating the brain information (e.g., lesions) without imaging sessions is beneficial for this scenario. Prospective estimating variables are non-imaging data collected from standard tests. Therefore, the current study aims to examine the variable feasibility for modelling lesion locations. Heterogeneous variables were employed in the multivariate logistic regression. Furthermore, patients were categorized (i.e., unsupervised clustering through k-means method) by the charasteristics of lesion occurrence (i.e., ratio between the lesioned and total regions) and sparsity (i.e., density measure of lesion occurrences across regions). Considering those charasteristics in models improved estimation performances. Lesions (116 regions in Automated Anatomical Labeling) were adequately predicted (sensitivity: 80.0-87.5% in median). We confirmed that the usability of models was extendable to different resolution levels in the brain region of interest (e.g., lobes, hemispheres). Patients' charateristics (i.e., occurrence and sparsity) might also be explained by the non-imaging data as well. Advantages of the current approach can be experienced by any patients (i.e., with or without imaging sessions) in any clinical facilities (i.e., with or without imaging instrumentation).
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Scholz ML, Collatz-Christensen H, Blomberg SNF, Boebel S, Verhoeven J, Krafft T. Artificial intelligence in Emergency Medical Services dispatching: assessing the potential impact of an automatic speech recognition software on stroke detection taking the Capital Region of Denmark as case in point. Scand J Trauma Resusc Emerg Med 2022; 30:36. [PMID: 35549978 PMCID: PMC9097123 DOI: 10.1186/s13049-022-01020-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Stroke recognition at the Emergency Medical Services (EMS) impacts the stroke treatment and thus the related health outcome. At the EMS Copenhagen 66.2% of strokes are detected by the Emergency Medical Dispatcher (EMD) and in Denmark approximately 50% of stroke patients arrive at the hospital within the time-to-treatment. An automatic speech recognition software (ASR) can increase the recognition of Out-of-Hospital cardiac arrest (OHCA) at the EMS by 16%. This research aims to analyse the potential impact an ASR could have on stroke recognition at the EMS Copenhagen and the related treatment. METHODS Stroke patient data (n = 9049) from the years 2016-2018 were analysed retrospectively, regarding correlations between stroke detection at the EMS and stroke specific, as well as personal characteristics such as stroke type, sex, age, weekday, time of day, year, EMS number contacted, and treatment. The possible increase in stroke detection through an ASR and the effect on stroke treatment was calculated based on the impact of an existing ASR to detect OHCA from CORTI AI. RESULTS The Chi-Square test with the respective post-hoc test identified a negative correlation between stroke detection and females, the 1813-Medical Helpline, as well as weekends, and a positive correlation between stroke detection and treatment and thrombolysis. While the association analysis showed a moderate correlation between stroke detection and treatment the correlation to the other treatment options was weak or very weak. A potential increase in stroke detection to 61.19% with an ASR and hence an increase of thrombolysis by 5% in stroke patients calling within time-to-treatment was predicted. CONCLUSIONS An ASR can potentially improve stroke recognition by EMDs and subsequent stroke treatment at the EMS Copenhagen. Based on the analysis results improvement of stroke recognition is particularly relevant for females, younger stroke patients, calls received through the 1813-Medical Helpline, and on weekends. TRIAL REGISTRATION This study was registered at the Danish Data Protection Agency (PVH-2014-002) and the Danish Patient Safety Authority (R-21013122).
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Affiliation(s)
- Mirjam Lisa Scholz
- Emergency Medical Services, Capital Region of Denmark, Telegrafvej 5, 2750 Ballerup, Denmark
- Department of Health, Ethics and Society, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands
| | | | | | - Simone Boebel
- Emergency Medical Services, Capital Region of Denmark, Telegrafvej 5, 2750 Ballerup, Denmark
- Department of Health, Ethics and Society, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands
| | - Jeske Verhoeven
- Emergency Medical Services, Capital Region of Denmark, Telegrafvej 5, 2750 Ballerup, Denmark
- Department of Health, Ethics and Society, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands
| | - Thomas Krafft
- Department of Health, Ethics and Society, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands
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Walter S, Phillips D, Wells B, Moon R, Bertsch T, Grunwald IQ, Fassbender K. Detection to Hospital Door: Gender Differences of Patients With Acute Stroke Symptoms. Front Neurol 2022; 13:833933. [PMID: 35463123 PMCID: PMC9021751 DOI: 10.3389/fneur.2022.833933] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/09/2022] [Indexed: 12/02/2022] Open
Abstract
Although prehospital stroke management is challenging, it is a crucial part of the acute stroke chain to enable equal access to highly specialised stroke care. It involves a critical understanding of players usually not specialized in acute stroke treatments. There is contradictory information about gender inequity in prehospital stroke detection, dispatch, and delivery to hospital stroke centers. The aim of this narrative review is to summarize the knowledge of gender differences in the first three stages of acute stroke management. Information on the detection of acute stroke symptoms by patients, their relatives, and bystanders is discussed. Women seem to have a better overall knowledge about stroke, although general understanding needs to be improved. However, older age and different social situations of women could be identified as reasons for reduced and delayed help-seeking. Dispatch and delivery lie within the responsibility of the emergency medical service. Differences in clinical presentation with symptoms mainly affecting general conditions could be identified as a crucial challenge leading to gender inequity in these stages. Improvement of stroke education has to be applied to tackle this inequal management. However, specifically designed projects and analyses are needed to understand more details of sex differences in prehospital stroke management, which is a necessary first step for the potential development of substantially improving strategies.
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Affiliation(s)
- Silke Walter
- Neurology, Saarland University, Homburg, Germany
- East of England Ambulance Service NHS Trust, Melbourn, United Kingdom
- *Correspondence: Silke Walter
| | - Daniel Phillips
- East of England Ambulance Service NHS Trust, Melbourn, United Kingdom
| | - Brittany Wells
- East of England Ambulance Service NHS Trust, Melbourn, United Kingdom
| | - Robert Moon
- East of England Ambulance Service NHS Trust, Melbourn, United Kingdom
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Iris Q. Grunwald
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, United Kingdom
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Rosário CFD, Fernandes Neto WG, Pessotti AL, Rodrigues BC, Baptista JD, Segatto M, Nunes VS, Barbosa LDA, Pereira AFA, Mota CL, Fiorot Júnior JA. Epidemiological analysis of stroke patients with emphasis on access to acute-phase therapies. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:117-124. [PMID: 35195222 DOI: 10.1590/0004-282x-anp-2020-0466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/13/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Stroke is a public health problem. For patients with ischemic stroke, venous thrombolysis and mechanical thrombectomy are effective therapeutic options. However, even after the National Stroke Treatment Guidelines were published in 2012, the number of cases treated is still lower than expected. OBJECTIVE To identify the determining factors for obtaining access to acute-phase therapies in the state of Espírito Santo (ES) and investigate the profile of stroke patients treated at the Central State Hospital (HEC). METHODS Retrospective data from the medical records of 1078 patients from May 2018 to December 2019 were analyzed. RESULTS Among the 1,078 patients, 54.9% were men and the most prevalent age group was 60 to 79 years. Systemic arterial hypertension was the main single risk factor. Regarding treatment modality among the patients who arrived at the HEC within the therapeutic window, 47% received some type of acute-phase therapy. Waking up with the deficit was the main contraindication for venous thrombolysis in these cases. CONCLUSIONS Application of the flowchart established by SESA-ES seemed to be effective for enabling responsiveness of care for stroke victims. Public emergency transport services had a fundamental role in this process. In addition, the care provided by the tertiary stroke center provided excellent access to acute-phase therapies. However, despite the efficiency of the service provided at the HEC, it only reached a maximum of 50% of the ES population. This service model therefore needs to be expanded throughout the state.
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Loh HC, Neoh KK, Tang ASN, Chin CJ, Suppiah PD, Looi I, Goh KW, Tan CS, Ming LC. Stroke Patients' Characteristics and Clinical Outcomes: A Pre-Post COVID-19 Comparison Study. ACTA ACUST UNITED AC 2021; 57:medicina57050507. [PMID: 34069433 PMCID: PMC8159102 DOI: 10.3390/medicina57050507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The Coronavirus disease 2019 (COVID-19) pandemic caused significant disruption to established medical care systems globally. Thus, this study was aimed to compare the admission and outcome variables such as number of patient and its severity, acute recanalisation therapy given pre-post COVID-19 at a primary stroke centre located in Malaysia. Methods: This cross-sectional hospital-based study included adult ischaemic stroke patients. Variables of the study included the number of ischaemic stroke patients, the proportions of recanalisation therapies, stroke severity during admission based on the National Institutes of Health Stroke Scale, functional outcome at discharge based on the modified Rankin Scale, and relevant workflow metrics. We compared the outcome between two six-month periods, namely the pre-COVID-19 period (March 2019 to September 2019) and the COVID-19 period (March 2020 to September 2020). Results: There were 131 and 156 patients, respectively, from the pre-COVID-19 period and the COVID-19 period. The median door-to-scan time and the median door-to-reperfusion time were both significantly shorter in the COVID-19 period (24.5 min versus 12.0 min, p = 0.047) and (93.5 min versus 60.0 min, p = 0.015), respectively. There were also significantly more patients who received intravenous thrombolysis (7.6% versus 17.3%, p = 0.015) and mechanical thrombectomy (0.8% versus 6.4%, p = 0.013) in the COVID-19 period, respectively. Conclusions: The COVID-19 pandemic may not have caused disruptions of acute stroke care in our primary stroke centre. Our data indicated that the number of ischaemic stroke events remained stable, with a significant increase of recanalisation therapies and better in-hospital workflow metrics during the COVID-19 pandemic period. However, we would like to highlight that the burden of COVID-19 cases in the study area was very low. Therefore, the study may not have captured the true burden (and relevant delays in stroke patient management) during the COVID-19 pandemic. The effect of the pandemic crisis is ongoing and both pre-hospital and in-hospital care systems must continue to provide optimal, highly time-dependent stroke care services.
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Affiliation(s)
- Hong Chuan Loh
- Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya 13700, Malaysia; (C.J.C.); (P.D.S.); (I.L.)
- Correspondence: (H.C.L.); (L.C.M.)
| | - Kar Keong Neoh
- Department of Internal Medicine, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya 13700, Malaysia; (K.K.N.); (A.S.N.T.)
| | - Angelina Siing Ngi Tang
- Department of Internal Medicine, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya 13700, Malaysia; (K.K.N.); (A.S.N.T.)
| | - Chen Joo Chin
- Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya 13700, Malaysia; (C.J.C.); (P.D.S.); (I.L.)
| | - Purnima Devi Suppiah
- Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya 13700, Malaysia; (C.J.C.); (P.D.S.); (I.L.)
| | - Irene Looi
- Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya 13700, Malaysia; (C.J.C.); (P.D.S.); (I.L.)
- Department of Internal Medicine, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya 13700, Malaysia; (K.K.N.); (A.S.N.T.)
| | - Khang Wen Goh
- Faculty of Computing and Engineering, Quest International University Perak, Ipoh 30250, Malaysia;
| | - Ching Siang Tan
- School of Pharmacy, KPJ Healthcare University College, Nilai 71800, Malaysia;
| | - Long Chiau Ming
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei
- Correspondence: (H.C.L.); (L.C.M.)
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14
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Bat-Erdene BO, Saver JL. Automatic Acute Stroke Symptom Detection and Emergency Medical Systems Alerting by Mobile Health Technologies: A Review. J Stroke Cerebrovasc Dis 2021; 30:105826. [PMID: 33932749 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/28/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To survey recent advances in acute stroke symptom automatic detection and Emergency Medical Systems (EMS) alerting by mobile health technologies. MATERIALS AND METHODS Narrative review RESULTS: Delayed activation of EMS for stroke symptoms by patients and witnesses deprives patients of rapid access to brain-saving therapies and occurs due to public unawareness of stroke features, cognitive and motor deficits produced by the stroke itself, and sleep onset. A promising emerging approach to overcoming the inherent biologic constraints of patient capacity to self-detect and respond to stroke symptoms is continuous monitoring by mobile health technologies with wireless sensors and artificial intelligence recognition systems. This review surveys 11 sensing technologies - accelerometers, gyroscopes, magnetometers, pressure sensors, touch screen and keyboard input detectors, artificial vision, and artificial hearing; and 10 consumer device form factors in which they are increasingly implemented: smartphones, smart speakers, smart watches and fitness bands, smart speakers/voice assistants, home health robots, smart clothing, smart beds, closed circuit television, smart rings, and desktop/laptop/tablet computers. CONCLUSIONS The increase in computing power, wearable sensors, and mobile connectivity have ushered in an array of mobile health technologies that can transform stroke detection and EMS activation. By continuously monitoring a diverse range of biometric parameters, commercially available devices provide the technologic capability to detect cardinal language, motor, gait, and sensory signs of stroke onset. Intensified translational research to convert the promise of these technologies to validated, accurate real-world deployments are an important next priority for stroke investigation.
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Affiliation(s)
- Bat-Orgil Bat-Erdene
- Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine at UCLA, Sukhbaatar District, Khoroo-1, 42-55, 11000 Ulaanbaatar, Mongolia.
| | - Jeffrey L Saver
- Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine at UCLA, Sukhbaatar District, Khoroo-1, 42-55, 11000 Ulaanbaatar, Mongolia
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15
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Eliakundu AL, Cadilhac DA, Kim J, Andrew NE, Bladin CF, Grimley R, Dewey HM, Donnan GA, Hill K, Levi CR, Middleton S, Anderson CS, Lannin NA, Kilkenny MF. Factors associated with arrival by ambulance for patients with stroke: a multicentre, national data linkage study. Australas Emerg Care 2021; 24:167-173. [PMID: 33642255 DOI: 10.1016/j.auec.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hospital arrival via ambulance influences treatment of acute stroke. We aimed to determine the factors associated with use of ambulance and access to evidence-based care among patients with stroke. METHODS Patients with first-ever strokes from the Australian Stroke Clinical Registry (2010-2013) were linked with administrative data (emergency, hospital admissions). Multilevel, multivariable regression models were used to determine patient, clinical and system factors associated with arrival by ambulance. RESULTS Among the 6,262 patients with first-ever stroke, 4,737 (76%) arrived by ambulance (52% male; 80% ischaemic). Patients who were older, frailer, with comorbidities or were unable to walk on admission (stroke severity) were more likely to arrive by ambulance to hospital. Compared to those using other means of transport, those who used ambulances arrived to hospital sooner after stroke onset (minutes, 124 vs 397) and were more likely to receive reperfusion therapy (adjusted odds ratio, 1.57, 95% CI: 1.09, 2.27). CONCLUSION Patients with stroke who use ambulances arrived faster and were more likely to receive reperfusion therapy compared to those using personal transport. Further public education about using ambulance services at all times, instead of personal transport when stroke is suspected is needed to optimise access to time critical care.
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Affiliation(s)
- Amminadab L Eliakundu
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Joosup Kim
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Christopher F Bladin
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Ambulance Victoria, Doncaster, Victoria, Australia
| | - Rohan Grimley
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Sunshine Coast Clinical School, Griffith University, Birtinya, Queensland, Australia
| | - Helen M Dewey
- Eastern Health Clinical School, Box Hill, Victoria, Australia
| | - Geoffrey A Donnan
- Melbourne Brain Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Kelvin Hill
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Stroke Foundation, Victoria, Australia
| | - Christopher R Levi
- Acute Stroke Services, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne &Australian Catholic University
| | - Craig S Anderson
- The George Institute for Global Health and Faculty of Medicine, University of New South Wales, New South Wales, Australia
| | - Natasha A Lannin
- Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.
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Amtoft AC, Danielsen AK, Hornnes N, Kruuse C. A Qualitative Inquiry Into Patient Reported Factors That Influence Time From Stroke Symptom Onset to Hospitalization. J Neurosci Nurs 2021; 53:5-10. [PMID: 33323718 DOI: 10.1097/jnn.0000000000000557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT BACKGROUND: Approximately 50% of Danish stroke patients did not arrive within the 4.5-hour revascularization window in 2018, and only 20% received acute revascularization therapy. Delay in seeking help was a major factor for missing the time window. This study explored patient-reported factors influencing the timing of a decision to seek help. METHODS: We performed a qualitative interview study to explore prehospital help-seeking behavior. Inclusion was guided by a purposive sampling of stroke and transient ischemic attack patients and, if necessary, bystanders. Semistructured explorative interviews with 8 patients and 2 bystanders were audio-recorded, transcribed verbatim, and analyzed via thematic analysis. RESULTS: Analysis yielded 3 main themes: (1) symptom interpretation, (2) barriers and enablers to response, and (3) participant suggested optimization of acute stroke response and awareness. DISCUSSION: Factors associated with prompt action to seek help were either a perception that the symptom indicated a serious illness or a strong emotional response. Patients with recurrent stroke failed to associate symptoms with a new stroke. Having a stroke in unfamiliar surroundings prompted delay in seeking help. Suggestions for optimization included targeted stroke campaigns. CONCLUSION: Response to stroke onset may be driven by perceptions of symptom severity and emotional response rather than the ability to correctly identify symptoms. Stroke education should include the information that new stroke symptoms may be different from the old ones because different parts of the brain may be affected.
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Gorlicki J, Adnet F, Bouamra B, D’Araujo L, L’hermitte Y, Deltour S. Prise en charge en phase aiguë des patients suspects d’accident vasculaire cérébral : étude EpisignAVC. ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2020-0298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : Les patients présentant des signes d’accident vasculaire cérébral (AVC) nécessitent une prise en charge rapide. En France, il a été mis en place une filière « neurovasculaire » dédiée à ces patients. L’objectif de cette étude était de décrire la filière de prise en charge des patients présentant des signes évocateurs d’AVC dans le système de soins français.
Méthodes : Étude prospective observationnelle de courte durée pendant trois jours dans 35 régulations Samu, 27 Smur et 85 services d’urgences en France, incluant tout patient de plus de 18 ans présentant un signe évocateur d’AVC ou d’accident ischémique transitoire (AIT). Les patients suivaient ou non la filière neurovasculaire définie au préalable.
Résultats : Du 29 novembre au 1er décembre 2016, 827 patients ont été inclus, d’âge moyen 68 ans. Parmi eux, 418 avaient un AVC confirmé, dont 231 accidents ischémiques constitués. La filière UNVa été suivie pour 279 patients (44 %). Le délai médian de prise en charge médicale était de 3 heures 49. Pour les patients avec AVC confirmé, ce délai était significativement plus court dans la filière neurovasculaire (2 heures 45 vs 5 heures 56 ; p < 0,001).
Conclusion : En France, la prise en charge dans une filière dédiée des patients suspects d’AVC n’est actuellement effective que dans la moitié des cas. Cette filière nécessite d’être promue.
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Dos Santos A, Mohr K, Jude M, Simon NG, Parsons M, Eades S, Burchill L, Davis S, Donnan G, Churliov L, Delcourt C. A prospective analysis of stroke recognition, stroke risk factors, thrombolysis rates and outcomes in Indigenous Australians from a large rural referral hospital. Intern Med J 2020; 52:468-473. [PMID: 33012066 DOI: 10.1111/imj.15080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death and disability in Indigenous communities but limited prospective data exists about stroke. AIM To estimate the difference in stroke recognition, risk factors, treatment rates and outcomes between Indigenous and non-Indigenous peoples admitted to the Wagga Wagga Rural Referral Hospital (WWRRH) over a 5-year period with a suspected acute stroke. METHODS All suspected strokes presenting to the 33 peripheral hospitals within the Murrumbidgee local health district (MLHD) were transferred to the WWRRH and prospectively assessed over a 5-year period from 01/01/2012 to 31/12/2017. Actions at stroke onset, risks factors, stroke type, treatment and outcomes were analysed. RESULTS 1843 patients were included. Of these, 45 patients (2.5%) were Indigenous. Only 26.6% of Indigenous and 34% of non-Indigenous patients knew of the fast acronym. Indigenous patients were younger (mean age 62.0 years versus 74.4 years) and more likely to have diabetes (RD 22.3% [95% CI: 3%,41.7%]), dyslipidaemia (RD 19.4% [95% CI: 21.%, 36.7%]), and be ever smokers (RD 24.9% [95% CI: 9.5%,40.3%]). Stroke types were similar except lacunar infarcts were more common (19.2% versus 8.4%). Treatment rates and outcomes were similar between the two groups. CONCLUSIONS Indigenous Australians with stroke are a decade younger and have a higher prevalence of important, modifiable stroke risk factors. Delayed presentation to hospital is more common, due in part to stroke symptoms being under recognized. When admitted to a specialized stroke unit, treatment rates and outcomes are comparable. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Angela Dos Santos
- Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, Victoria, Australia. The Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Martin Jude
- The Wagga Wagga Rural Referral Hospital. The University of New South Wales, Rural Clinical School, Wagga Wagga, Australia
| | - Neil G Simon
- Northern Clinical School, The University of Sydney, Australia
| | - Mark Parsons
- Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, Victoria, Australia. The Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sandra Eades
- The Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Luke Burchill
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne
| | - Stephen Davis
- Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, Victoria, Australia. The Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Geoffrey Donnan
- Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, Victoria, Australia. The Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leonid Churliov
- Department of Medicine (Austin Health) and Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Candice Delcourt
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia. Royal Prince Alfred Hospital, The University of Sydney, Sydney, Australia
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19
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Iversen AB, Blauenfeldt RA, Johnsen SP, Sandal BF, Christensen B, Andersen G, Christensen MB. Understanding the seriousness of a stroke is essential for appropriate help-seeking and early arrival at a stroke centre: A cross-sectional study of stroke patients and their bystanders. Eur Stroke J 2020; 5:351-361. [PMID: 33598553 DOI: 10.1177/2396987320945834] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/05/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Only a minority of patients with acute ischaemic stroke receive reperfusion treatment, primarily due to prehospital delay. We aimed to investigate predictors of a primary contact to the emergency medical services, arrival at stroke centre within 3 h of symptom onset and initiation of reperfusion therapy in patients with acute stroke. Patients and methods We conducted a cross-sectional study of consecutive patients with acute ischaemic stroke, intracerebral haemorrhage or transient ischaemic attack. Structured interviews of patients and bystanders were performed and combined with clinical information from the Danish Stroke Registry. Eligible patients were aged ≥18 years and were independent in activities of daily living before the stroke. Results We included 435 patients. Presence of a bystander at symptom onset and knowledge of ≥2 core symptoms of stroke were associated with a primary emergency medical services contact. Higher stroke severity and patients or bystanders perceiving the situation as very serious were associated with a primary emergency medical services contact (ORpatients 2.10; 95% CI 1.12-3.95 and ORbystanders 22.60; 95% CI 4.98-102.67), <3 h from onset to arrival (ORpatients 3.01; 95% CI 1.46-6.21 and ORbystanders 4.44; 95% CI 1.37-14.39) and initiation of reperfusion therapy (ORpatients 3.08; 95% CI 1.23-7.75 and ORbystanders 4.70; 95% CI 1.14-19.5).Conclusion: Having a bystander, knowledge of ≥2 core symptoms and understanding that stroke is a serious event are associated with appropriate help-seeking behaviour, shorter prehospital delay and higher chance of reperfusion therapy in acute stroke patients.
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Affiliation(s)
- Ane Bull Iversen
- Department of Clinical Medicine - Neurology, Aarhus University, Aarhus N, Denmark.,Research Unit for General Practice, Aarhus C, Denmark.,Department of Public Health, Aarhus University, Aarhus C, Denmark
| | | | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Birgitte F Sandal
- Department of Neurology, Regional Hospital of West Jutland, Holstebro, Denmark
| | - Bo Christensen
- Research Unit for General Practice, Aarhus C, Denmark.,Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Grethe Andersen
- Department of Clinical Medicine - Neurology, Aarhus University, Aarhus N, Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice, Aarhus C, Denmark.,Department of Public Health, Aarhus University, Aarhus C, Denmark
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20
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Variation in Knowledge of Stroke Warning Signs by Age and Presence of Conventional Risk Factors: A Community Health Survey in Korea. J Cardiovasc Nurs 2020; 37:177-183. [PMID: 32740227 DOI: 10.1097/jcn.0000000000000736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is important to recognize stroke in the general public. OBJECTIVES The purpose of this study was to investigate factors affecting knowledge of stroke warning signs (SWSs) according to age group in the Korean population. METHODS This study is a cross-sectional study. Using data from the Korean Community Health Survey conducted in Korea in 2017, 198 403 subjects were analyzed. Knowledge about SWSs was assessed by face-to-face interviews using structured close-ended questionnaires with 5 items about stroke symptoms (sudden unilateral weakness of face, arm or leg; sudden difficulty in speaking, or trouble understanding speech; sudden visual impairment in 1 eye, or double vision; sudden dizziness or loss of balance; and sudden severe headache). RESULTS The overall percentage of subjects with good knowledge of SWSs (>4 correct answers to the SWS questionnaire) was 66.5%. It was highest in the middle-aged subjects (72.6%), followed by the young subjects (63.5%) and the older subjects (61.5%). The youngest of the young subjects and the oldest of the older subjects had the least knowledge. Subjects with conventional risk factors generally had more knowledge about SWSs, except for those with diabetes mellitus. However, in the young subjects, knowledge about SWSs was not increased by the presence of conventional risk factors such as hypertension and dyslipidemia. CONCLUSION Stoke risk factors are increasing among young people; they still have poor knowledge about SWSs. More education is needed to increase appropriate treatment, especially in young people with stroke-related risk factors.
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Xirasagar S, Tsai MH, Heidari K, Hardin JW, Wu Y, Wronski R, Hurley D, Jauch EC, Sen S. Why acute ischemic stroke patients in the United States use or do not use emergency medical services transport? Findings of an inpatient survey. BMC Health Serv Res 2019; 19:929. [PMID: 31796059 PMCID: PMC6892139 DOI: 10.1186/s12913-019-4741-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/13/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Patients with acute ischemic stroke (AIS) who use emergency medical services (EMS) receive quicker reperfusion treatment which, in turn, mitigates post-stroke disability. However, nationally only 59% use EMS. We examined why AIS patients use or do not use EMS. METHODS During 2016-2018, a convenience sample of AIS patients admitted to a primary stroke center in South Carolina were surveyed during hospitalization if they were medically fit, available for survey when contacted, and consented to participate. The survey was programed into EpiInfo with skip patterns to minimize survey burden and self-administered on a touchscreen computer. Survey questions covered symptom characteristics, knowledge of stroke and EMS importance, subjective reactions, role of bystanders and financial factors. Descriptive and multiple regression analyses were performed. RESULTS Of 108 inpatients surveyed (out of 1179 AIS admissions), 49% were male, 44% African American, mean age 63.5 years, 59% mild strokes, 75 (69%) arrived by EMS, 33% were unaware of any stroke symptom prior to stroke, and 75% were unaware of the importance of EMS use for good outcome. Significant factors that influenced EMS use decisions (identified by regression analysis adjusting for stroke severity) were: prior familiarity with stroke (self or family/friend with stroke) adjusted odds ratio, 5.0 (95% confidence interval, 1.6, 15.1), perceiving symptoms as relevant for self and indicating possible stroke, 26.3 (7.6, 91.1), and bystander discouragement to call 911, 0.1 (0.01,0.7). Further, all 27 patients who knew the importance of EMS had used EMS. All patients whose physician office advised actions other than calling EMS at symptom onset, did not use EMS. CONCLUSION Systematic stroke education of patients with stroke-relevant comorbidities and life-style risk factors, and public health educational programs may increase EMS use and mitigate post-stroke disability.
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Affiliation(s)
- Sudha Xirasagar
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208 USA
| | - Meng-han Tsai
- Department of Health, Human Services and Public Policy, California State University–Monterey Bay, Seaside, CA USA
| | | | - James W. Hardin
- Arnold School of Public Health, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Yuqi Wu
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208 USA
| | - Robert Wronski
- Bureau of Emergency Medical Services, South Carolina Department of Health and Environmental Control, Columbia, SC USA
| | - Dana Hurley
- Genentech, Inc., South San Francisco, CA USA
| | - Edward C. Jauch
- Department of Emergency Medicine, Department of Neurosciences, Mission Research Institute, Mission Health, Asheville, NC USA
| | - Souvik Sen
- University of South Carolina School of Medicine and Prisma Health Midlands Richland Stroke Unit, Columbia, SC USA
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Li S, Cui LY, Anderson C, Gao C, Yu C, Shan G, Wang L, Peng B. Barriers from calling ambulance after recognizing stroke differed in adults younger or older than 75 years old in China. BMC Neurol 2019; 19:283. [PMID: 31718577 PMCID: PMC6852842 DOI: 10.1186/s12883-019-1480-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/30/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND As health behavior varies with increasing age, we aimed to examine the potential barriers in calling emergency medical services (EMS) after recognizing a stroke among 40-74- and 75-99-year-old adults. METHODS Data were obtained from a cross-sectional community-based study (FAST-RIGHT) that was conducted from January 2017 to May 2017 and involved adults (age ≥ 40 years) across 69 administrative areas in China. A subgroup of residents (153675) who recognized stroke symptoms was analyzed. Multivariable logistic regression models were performed in the 40-74 and 75-99 age groups, separately, to determine the factors associated with wait-and-see behaviors at the onset of a stroke. RESULTS In the 40-74 and 75-99 age groups, the rates of participants who chose "Self-observation at home" were 3.0% (3912) and 3.5% (738), respectively; the rates of "Wait for family, then go to hospital" were 31.7% (42071) and 33.1% (6957), respectively. Rural residence, living with one's spouse, low income (< 731 US $ per annum), having a single avenue to learn about stroke, and having friends with stroke were factors associated with waiting for one's family in both groups. However, unlike in the 40-74 age group, sex, number of children, family history, and stroke history did not influence the behaviors at stroke onset in the 75-99 age group. CONCLUSIONS Different barriers from recognizing stroke and calling an ambulance exist in the 40-74 and 75-99 age groups in this specific population. Different strategies that mainly focus on changing the "Wait for family" behavior and emphasize on immediately calling EMS are recommended for both age groups.
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Affiliation(s)
- Shengde Li
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuaifuyuan1, Dong Cheng District, Beijing, 100730, China
| | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuaifuyuan1, Dong Cheng District, Beijing, 100730, China
| | - Craig Anderson
- Neurological and Mental Health Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China
| | - Chunpeng Gao
- Disease Control and Prevention Office, Dalian Municipal Central Hospital, Liaoning, China
| | - Chengdong Yu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Longde Wang
- Stroke Control Project Committee, The National Health Commission, Beijing, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuaifuyuan1, Dong Cheng District, Beijing, 100730, China.
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Morrow A, Miller CB, Dombrowski SU. Can people apply 'FAST' when it really matters? A qualitative study guided by the common sense self-regulation model. BMC Public Health 2019; 19:643. [PMID: 31138193 PMCID: PMC6537353 DOI: 10.1186/s12889-019-7032-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/22/2019] [Indexed: 11/11/2022] Open
Abstract
Background Early identification of stroke symptoms and rapid access to the emergency services increases an individual’s chance of receiving thrombolytic therapy and reduces the likelihood of infirmity. The UK’s national stroke campaign ‘Act FAST’ was developed to increase public awareness of stroke symptoms and highlighted the importance of rapid response by contacting emergency services. No study to date has assessed if and how people who experienced or witnessed stroke in line with the campaigns’ symptoms of the FAST acronym (i.e., facial weakness, arm weakness, slurred speech, and time) may use this FAST in their response. Methods Semi-structured interviews with 13 stroke patients and witnesses were conducted. Interviews were theory-guided based on the Common Sense Self-Regulation Model, to understand the appraisal process of the onset of stroke symptoms and how this impacted on participants’ ability to apply their knowledge of the FAST campaign. Results The majority of patients (n = 8/13) failed to correctly identify stroke and reported no impact of the campaign on their stroke recognition and response. Inability to identify stroke, perceiving symptoms to lack severity and lack of control contributed to a delay in seeking medical attention. Conclusion Stroke witnesses and patients predominantly fail to identify stroke which suggest a lack of FAST application when it matters. Inaccurate risk perceptions and lack of physical control both play central roles in influencing the formation of illness representation not associated with an appropriate emergency response.
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Affiliation(s)
- Alison Morrow
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK
| | - Christopher B Miller
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK.
| | - Stephan U Dombrowski
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK.,Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
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Schewe JC, Kappler J, Dovermann K, Graeff I, Ehrentraut SF, Heister U, Hoeft A, Weber SU, Muenster S. Diagnostic accuracy of physician-staffed emergency medical teams: a retrospective observational cohort study of prehospital versus hospital diagnosis in a 10-year interval. Scand J Trauma Resusc Emerg Med 2019; 27:36. [PMID: 30940205 PMCID: PMC6446382 DOI: 10.1186/s13049-019-0617-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 03/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In Germany, emergency medical teams are staffed with physicians but evidence regarding their prehospital diagnostic accuracy remains poor. OBJECTIVE To evaluate the out-of-hospital diagnostic accuracy of physician-staffed emergency medical teams (PEMTs). METHODS A retrospective observational cohort study involving the Emergency Medical Service Bonn, Germany, from January to December 2004 and 2014 respectively. A total of 8346 patients underwent medical treatment by PEMTs, of which 1960 adult patients (inclusion criteria: ≥18 years of age, hospital diagnosis available) were included for further analysis. Reasons for non-inclusion: death on scene, outpatient, interhospital transfer, mental illness, false alarm, no hospital medical history available. The overall diagnostic accuracy (correct or false) of PEMTs was measured after matching the prehospital diagnosis with the corresponding diagnosis of the hospital. Secondary outcome measures were incidence of common PEMT diagnoses (acute coronary syndrome (ACS), dyspnea, stroke/intracerebral bleeding), recognition rate of a given disease by PEMTs, and prehospital diagnostic accuracy in elderly patients. RESULTS PEMT calls increased 2-fold over a decade (2004: n = 3151 vs. 2014: n = 5195). Overall diagnostic accuracy of PEMTs increased from 87.5% in 2004 to 92.6% in the year 2014. The incidence of common PEMT diagnoses such as ACS, dyspnea or stroke/intracerebral bleeding increased 2-fold from 2004 to 2014. The recognition rate of a given disease by the PEMT varied between 2004 and 2014: an increase was observed when a stroke/intracerebral bleeding was diagnosed (2004: 67% vs. 2014: 83%; p = 0.054), a decreased rate of recognition occurred when a syncope/collapse was diagnosed (2004: 81% vs. 2014: 56%; p = 0.007) and a sepsis appears to be a rare event for EMS personnel (2004: 0% vs. 2014: 23%). Linear regression analysis revealed that the prehospital diagnostic accuracy decreases in the elderly patient. CONCLUSIONS The overall prehospital diagnostic accuracy of PEMTs improved between the year 2004 and 2014 respectively. Our findings suggest that the incidence of common diseases (ACS, dyspnea stroke/intracerebral bleeding, sepsis) increased over a 10-year period. Diagnostic accuracy of different diseases varied but generally decreased in the elderly patient. Regular training of EMS personnel and public campaigns should be implemented to improve the diagnostic accuracy in the future.
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Affiliation(s)
- Jens-Christian Schewe
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Jochen Kappler
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Katharina Dovermann
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Ingo Graeff
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
- Department of Emergency Medicine, Bonn, University Hospital Bonn, Bonn, Germany
| | - Stefan Felix Ehrentraut
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Ulrich Heister
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
- Emergency Medical Service Bonn, Bonn, Germany
| | - Andreas Hoeft
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Stefan Ulrich Weber
- Department of Anesthesiology, Critical Care and Pain Medicine, Heilig Geist Krankenhaus, Cologne, Germany
| | - Stefan Muenster
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
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Li S, Cui LY, Anderson C, Zhu S, Xu P, Wei T, Luo Y, Chen S, Jiang N, Hong Y, Liu W, Li J, Gao C, Yu C, Shan G, Wang L, Peng B. Public Awareness of Stroke and the Appropriate Responses in China: A Cross-Sectional Community-Based Study (FAST-RIGHT). Stroke 2019; 50:455-462. [PMID: 32125134 DOI: 10.1161/strokeaha.118.023317] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—Early presentation is critical for receiving effective reperfusion therapy for acute ischemic
stroke, therefore, we undertook a national survey of awareness and responses to acute stroke symptoms in China.
Methods—We undertook a cross-sectional community-based study of 187 723 adults (age ≥40 years) presenting to 69
administrative areas across China between January 2017 and May 2017 to determine the national stroke recognition rate
and the correct action rate. Multivariable logistic regression models were used to identify factors associated with stroke
recognition and intention-to-avail emergency medical services.
Results—Estimates of stroke recognition rate and correct action rate were 81.9% (153 675/187723) and 60.9%
(114 380/187723), respectively, but these rates varied widely by sociodemographic status, region, and stroke risk.
Approximately one-third of participants who recognized a stroke failed to call emergency medical service. Low likelihood
of emergency medical service use was associated with younger age (40–59 years), being male, rural location, (regions of
east, south, and northwest China), high body mass index (≥24), low education (primary school or below), low personal
income (<US $731 per annum), living with immediate family, having multiple children (≥2), having a friend with stroke,
exposure to less avenues to learn about stroke, nonsmoking, regular exercise, unknown family history, and no history of
cardiovascular disease. Intention of calling emergency medical service was strongly related to awareness of stroke (odds
ratio 2.05; 95% CI, 2.00–2.10; P<0.001).
Conclusions—Substantial discrepancies exist between stroke recognition and correct action and not all stroke patients
know the appropriate responses. Further, national stroke educational programs with specific plans targeting different
groups are needed, which do not solely focus on stroke recognition, but also on the appropriate responses at the time of a
stroke.
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Affiliation(s)
- Shengde Li
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences,
Beijing, China (S.L., L.C., N.J., Y.H., B.P.)
| | - Li-Ying Cui
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences,
Beijing, China (S.L., L.C., N.J., Y.H., B.P.)
| | - Craig Anderson
- Neurological and Mental Health Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (C.A.),The George Institute for Global Health, Peking University Health Science Center, Beijing, China (C.A.)
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (S.Z.)
| | - Ping Xu
- Department of Neurology, Changde First People’s Hospital, Hunan, China (P.X.)
| | - Tiemin Wei
- Department of Neurology, Changde First People’s Hospital, Hunan, China (P.X.); Department of Cardiology, Lishui Hospital of Zhejiang University (the Central Hospital of Lishui), China (T.W.)
| | - Yun Luo
- Department of Cardiovascular, First People’s Hospital of Jiujiang, Jiangxi, China (Y.L.)
| | - Shengli Chen
- Department of Neurology, Chongqing Three Gorges Central Hospital, China (S.C.)
| | - Nan Jiang
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences,
Beijing, China (S.L., L.C., N.J., Y.H., B.P.)
| | - Yuehui Hong
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences,
Beijing, China (S.L., L.C., N.J., Y.H., B.P.)
| | - Weidong Liu
- Neurosurgical Department, Liaocheng People’s Hospital, Shandong, China (W.L.)
| | - Jian Li
- Neurology Department, Affiliated Hospital of Weifang Medical University, Shandong, China (J.L.)
| | - Chunpeng Gao
- Disease Control and Prevention Office, Dalian Municipal Central Hospital, Liaoning, China (C.G.)
| | - Chengdong Yu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China (C.Y., G.S.)
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China (C.Y., G.S.)
| | - Longde Wang
- Stroke Control Project Committee, The National Health Commission, Beijing, China (L.W.)
| | - Bin Peng
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences,
Beijing, China (S.L., L.C., N.J., Y.H., B.P.)
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Kinsella D, Mosley I, Braitberg G. A Retrospective Study Investigating: Factors associated with mode of arrival and emergency department management for patients with acute stroke. Australas Emerg Care 2018; 21:99-104. [PMID: 30998885 DOI: 10.1016/j.auec.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Presentation by ambulance to the emergency department is critical for stroke patients to receive time dependent treatments. However, little is known of the factors that influence presentation by ambulance. METHODS Retrospective analysis of all patients with an emergency department medical diagnosis of stroke who presented to one of three Victorian emergency departments over a three-year period (2011-2013). A multivariable model was used to investigate demographic characteristics (including triage assessment category, triage identified as stroke, time to CT, and time to diagnosis within the emergency department) as predictors of arrival by ambulance. RESULTS 3548 stroke patients were identified; mean age was 70 years, 53% were males, and 92% had an ischemic stroke. Arrival by ambulance occurred in 71% (n=2509) with arrival by private transport accounting for 29% (n=1039) of patients. Factors significantly associated with arrival by ambulance were older age (p=<0.001), being born in Australia (p=<0.001), and speaking English in the home (p=0.003). Arrival by ambulance was independently associated with rapid stroke care in the emergency department, arrival within 2h from symptom onset, attending an advanced stroke service (access to thrombolysis), triaged for stroke, medical assessment within 25min and referral for CT within 45min. CONCLUSION In this Australian multicenter study, it was identified that patients who arrived by ambulance received faster acute stroke care within the emergency department. Public health education which targets patients who are younger and from a non-English speaking background is needed as these demographics were not associated with timely arrival by ambulance to the emergency department.
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Affiliation(s)
- Danny Kinsella
- Alfred Health, Nursing Education, Australia; Sunshine Hospital, Neurology Department, Australia.
| | - Ian Mosley
- La Trobe University, School of Nursing & Midwifery, College of Science, Health & Engineering, Australia.
| | - George Braitberg
- University of Melbourne, Department of Medicine, Australia; Royal Melbourne Hospital, Emergency Department, Australia.
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Zhang S, Zhang J, Zhang M, Zhong G, Chen Z, Lin L, Lou M. Prehospital Notification Procedure Improves Stroke Outcome by Shortening Onset to Needle Time in Chinese Urban Area. Aging Dis 2018; 9:426-434. [PMID: 29896430 PMCID: PMC5988597 DOI: 10.14336/ad.2017.0601] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/01/2017] [Indexed: 11/16/2022] Open
Abstract
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) can improve clinical outcome in eligible patients with acute ischemic stroke (AIS). However, its efficacy is strongly time-dependent. This study was aimed to examine whether prehospital notification by emergency medical service (EMS) providers could reduce onset to needle time (ONT) and improve neurological outcome in AIS patients who received IVT. We prospectively collected the consecutive clinical and time data of AIS patients who received IVT during one year after the initiation of prehospital notification procedure (PNP). Patients were divided into three groups, including patients that transferred by EMS with and without PNP and other means of transportation (non-EMS). We then compared the effect of EMS with PNP and EMS use only on ONT, and the subsequent neurological outcome. Good outcome was defined as modified Rankin Scale score of 0-2 at 3-months. In 182 patients included in this study, 77 (42.3%) patients were transferred by EMS, of whom 41 (53.2%) patients entered PNP. Compared with non-EMS group, EMS without PNP group greatly shortened the onset to door time (ODT), but EMS with PNP group showed both a significantly shorter DNT (41.3 ± 10.7 min vs 51.9±23.8 min, t=2.583, p=0.012) and ODT (133.2 ± 90.2 min vs 174.8 ± 105.1 min, t=2.228, p=0.027) than non-EMS group. Multivariate analysis showed that the use of EMS with PNP (OR=2.613, p=0.036), but not EMS (OR=1.865, p=0.103), was independently associated with good outcome after adjusting for age and baseline NIHSS score. When adding ONT into the regression model, ONT (OR=0.994, p=0.001), but not EMS with PNP (OR=1.785, p=0.236), was independently associated with good outcome. EMS with PNP, rather than EMS only, improved stroke outcome by shortening ONT. PNP could be a feasible strategy for better stroke care in Chinese urban area.
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Affiliation(s)
- Sheng Zhang
- 1Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jungen Zhang
- 2Hangzhou Emergency Medical Center of Zhejiang Province, Hangzhou, China
| | - Meixia Zhang
- 1Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Genlong Zhong
- 1Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Zhicai Chen
- 1Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Longting Lin
- 3The School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Min Lou
- 1Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Ellensen EN, Naess H, Wisborg T, Hunskaar S, Zakariassen E. Stroke identification by criteria based dispatch - a register based study. Acta Anaesthesiol Scand 2018; 62:105-115. [PMID: 29105736 PMCID: PMC5725681 DOI: 10.1111/aas.13032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rapid and precise dispatch of resources is a key element in pre-hospital emergency medicine. Emergency medical communication centres (EMCCs) dispatch resources based on protocols and guidelines, balancing the acute need of the individual and the resource allocation of the pre-hospital emergency medical system. The aim of this study was to determine the validity of stroke identification by the Norwegian dispatch guidelines. METHOD AND MATERIAL This was a register-based study where patients suspected for stroke were compared to those with the final diagnosis of stroke as an indicator group for the guideline validation. One EMCC and its three associated hospitals participated with 13 months of data. Four subcodes of the stroke dispatch code were defined as suspicious of stroke and further analysed. Factors associated with stroke identification were explored. RESULTS The sensitivity for identifying a stroke patient at initial EMCC contact was 57.9% (51.5, 64.1), specificity was 99.1% (98.9, 99.2), positive predictive value was 45.7% (40.1, 51.4) and negative predictive value was 99.4% (99.3, 99.5). The emergency medical access telephone (113) was initial EMCC contact line in only 48% of the cases. Paralyses and admittance to a smaller hospital were associated with increased probability for stroke (OR 2.6, P = 0.001 and OR 2.7, P = 0.01), respectively. CONCLUSION The sensitivity for identification of stroke patients by the dispatch guidelines is modest, while the specificity is high. The 113 telephone line was initial EMCC access point for less than half of the stroke patients.
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Affiliation(s)
- E. N. Ellensen
- Department of Research; Norwegian Air Ambulance Foundation; Drøbak Norway
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
| | - H. Naess
- Department of Neurology; Haukeland University Hospital; Bergen Norway
- Centre for Age-Related Medicine; Stavanger University Hospital; Stavanger Norway
- Department of Clinical Medicine; University of Bergen; Bergen Norway
| | - T. Wisborg
- Faculty of Health Sciences; Anaesthesia and Critical Care Research Group; University of Tromsø; Tromsø Norway
- Norwegian National Advisory Unit on Trauma; Oslo University Hospital; Oslo Norway
| | - S. Hunskaar
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- National Centre for Emergency Primary Health Care; Uni Research Health; Bergen Norway
| | - E. Zakariassen
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- National Centre for Emergency Primary Health Care; Uni Research Health; Bergen Norway
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Novel Noninvasive Brain Disease Detection System Using a Facial Image Sensor. SENSORS 2017; 17:s17122843. [PMID: 29292716 PMCID: PMC5751555 DOI: 10.3390/s17122843] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 11/30/2017] [Accepted: 12/02/2017] [Indexed: 12/01/2022]
Abstract
Brain disease including any conditions or disabilities that affect the brain is fast becoming a leading cause of death. The traditional diagnostic methods of brain disease are time-consuming, inconvenient and non-patient friendly. As more and more individuals undergo examinations to determine if they suffer from any form of brain disease, developing noninvasive, efficient, and patient friendly detection systems will be beneficial. Therefore, in this paper, we propose a novel noninvasive brain disease detection system based on the analysis of facial colors. The system consists of four components. A facial image is first captured through a specialized sensor, where four facial key blocks are next located automatically from the various facial regions. Color features are extracted from each block to form a feature vector for classification via the Probabilistic Collaborative based Classifier. To thoroughly test the system and its performance, seven facial key block combinations were experimented. The best result was achieved using the second facial key block, where it showed that the Probabilistic Collaborative based Classifier is the most suitable. The overall performance of the proposed system achieves an accuracy −95%, a sensitivity −94.33%, a specificity −95.67%, and an average processing time (for one sample) of <1 min at brain disease detection.
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Vondráčková L, Mikulík R. Public stroke education: Current status worldwide and projects to increase awareness in the Czech Republic. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stojanovski B, Monagle PT, Mosley I, Churilov L, Newall F, Hocking G, Mackay MT. Prehospital Emergency Care in Childhood Arterial Ischemic Stroke. Stroke 2017; 48:1095-1097. [PMID: 28235958 DOI: 10.1161/strokeaha.116.014768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 12/19/2016] [Accepted: 12/28/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Immediately calling an ambulance is the key factor in reducing time to hospital presentation for adult stroke. Little is known about prehospital care in childhood arterial ischemic stroke (AIS). We aimed to determine emergency medical services call-taker and paramedic diagnostic sensitivity and to describe timelines of care in childhood AIS. METHODS This is a retrospective study of ambulance-transported children aged <18 years with first radiologically confirmed AIS, from 2008 to 2015. Interhospital transfers of children with preexisting AIS diagnosis were excluded. RESULTS Twenty-three children were identified; 4 with unavailable ambulance records were excluded. Nineteen children were included in the study. Median age was 8 years (interquartile range, 3-14); median Pediatric National Institutes of Stroke Severity Scale score was 8 (interquartile range, 3-16). Emergency medical services call-taker diagnosis was stroke in 4 children (21%). Priority code 1 (lights and sirens) ambulances were dispatched for 13 children (68%). Paramedic diagnosis was stroke in 5 children (26%), hospital prenotification occurred in 8 children (42%), and 13 children (68%) were transported to primary stroke centers. Median prehospital timelines were onset to emergency medical services contact 13 minutes, call to scene 12 minutes, time at scene 14 minutes, transport time 43 minutes, and total prehospital time 71 minutes (interquartile range, 60-85). CONCLUSIONS Emergency medical services call-taker and paramedic diagnostic sensitivity and prenotification rates are low in childhood AIS.
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Affiliation(s)
- Belinda Stojanovski
- From the Neurology Department (B.S., M.T.M.) and Haematology Department (P.T.M., F.N.), Royal Children's Hospital, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia (B.S., P.T.M., F.N., M.T.M.); Florey Neurosciences Institute, Victoria, Australia (L.C., M.T.M.); Department of Paediatrics, University of Melbourne, Victoria, Australia (P.T.M., F.N., M.T.M.); La Trobe University, Victoria, Australia (I.M.); and Ambulance Victoria, Australia (G.H.)
| | - Paul T Monagle
- From the Neurology Department (B.S., M.T.M.) and Haematology Department (P.T.M., F.N.), Royal Children's Hospital, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia (B.S., P.T.M., F.N., M.T.M.); Florey Neurosciences Institute, Victoria, Australia (L.C., M.T.M.); Department of Paediatrics, University of Melbourne, Victoria, Australia (P.T.M., F.N., M.T.M.); La Trobe University, Victoria, Australia (I.M.); and Ambulance Victoria, Australia (G.H.)
| | - Ian Mosley
- From the Neurology Department (B.S., M.T.M.) and Haematology Department (P.T.M., F.N.), Royal Children's Hospital, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia (B.S., P.T.M., F.N., M.T.M.); Florey Neurosciences Institute, Victoria, Australia (L.C., M.T.M.); Department of Paediatrics, University of Melbourne, Victoria, Australia (P.T.M., F.N., M.T.M.); La Trobe University, Victoria, Australia (I.M.); and Ambulance Victoria, Australia (G.H.)
| | - Leonid Churilov
- From the Neurology Department (B.S., M.T.M.) and Haematology Department (P.T.M., F.N.), Royal Children's Hospital, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia (B.S., P.T.M., F.N., M.T.M.); Florey Neurosciences Institute, Victoria, Australia (L.C., M.T.M.); Department of Paediatrics, University of Melbourne, Victoria, Australia (P.T.M., F.N., M.T.M.); La Trobe University, Victoria, Australia (I.M.); and Ambulance Victoria, Australia (G.H.)
| | - Fiona Newall
- From the Neurology Department (B.S., M.T.M.) and Haematology Department (P.T.M., F.N.), Royal Children's Hospital, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia (B.S., P.T.M., F.N., M.T.M.); Florey Neurosciences Institute, Victoria, Australia (L.C., M.T.M.); Department of Paediatrics, University of Melbourne, Victoria, Australia (P.T.M., F.N., M.T.M.); La Trobe University, Victoria, Australia (I.M.); and Ambulance Victoria, Australia (G.H.)
| | - Grant Hocking
- From the Neurology Department (B.S., M.T.M.) and Haematology Department (P.T.M., F.N.), Royal Children's Hospital, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia (B.S., P.T.M., F.N., M.T.M.); Florey Neurosciences Institute, Victoria, Australia (L.C., M.T.M.); Department of Paediatrics, University of Melbourne, Victoria, Australia (P.T.M., F.N., M.T.M.); La Trobe University, Victoria, Australia (I.M.); and Ambulance Victoria, Australia (G.H.)
| | - Mark T Mackay
- From the Neurology Department (B.S., M.T.M.) and Haematology Department (P.T.M., F.N.), Royal Children's Hospital, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia (B.S., P.T.M., F.N., M.T.M.); Florey Neurosciences Institute, Victoria, Australia (L.C., M.T.M.); Department of Paediatrics, University of Melbourne, Victoria, Australia (P.T.M., F.N., M.T.M.); La Trobe University, Victoria, Australia (I.M.); and Ambulance Victoria, Australia (G.H.).
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Shin CN, An K, Sim J. Facilitators of and barriers to emergency medical service use by acute ischemic stroke patients: A retrospective survey. Int J Nurs Sci 2017; 4:52-57. [PMID: 31406718 PMCID: PMC6626084 DOI: 10.1016/j.ijnss.2016.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 11/16/2016] [Accepted: 12/08/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of the study was to identify facilitators and barriers to emergency medical service use among acute ischemic stroke patients in Korea. METHODS This paper presents a secondary analysis of a retrospective survey that collected data from questionnaires and medical records. Among 233 acute ischemic stroke patients enrolled in a large-scale study, 160 patients who had arrived at a hospital within 72 h after symptom onset were included in the data analysis. RESULTS Users of emergency medical services needed a shorter time than non-users to arrive at hospital (140 min vs. 625 min., p = 0.001) and were more likely to arrive at hospital within 3 h of symptom onset (51.9% vs. 31.5%, p = 0.013). For those who first contacted emergency medical service, the facilitators of emergency medical service use were the presence of hemiparesis (p = 0.003), bilateral paralysis (p = 0.040), and loss of balance (p = 0.021). The predominant barrier was the failure to recognize the urgency of symptoms (p = 0.006). CONCLUSIONS The use of emergency medical services reduced prehospital delay and increased the likelihood of patient arrival at hospital within 3 h. Given that experiencing typical stroke symptoms was a facilitator of emergency medical service use yet failure to recognize the urgency of symptoms was a barrier, public awareness should be raised as regards stroke symptoms and the benefits of using emergency medical services.
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Affiliation(s)
- Cha-Nam Shin
- College of Nursing and Health Innovation, Arizona State University, 500 N. Third St., Phoenix, AZ 85004, United States
| | - Kyungeh An
- College of Nursing, Virginia Commonwealth University, 1100 E. Leigh St., Richmond, VA, United States
| | - Jeongha Sim
- Department of Nursing, Jeonju University, 303 Cheonjam-ro, Wansan-gu, Jeonju, 560-759, South Korea
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Zock E, Kerkhoff H, Kleyweg RP, van Bavel-Ta TBV, Scott S, Kruyt ND, Nederkoorn PJ, van de Beek D. Help seeking behavior and onset-to-alarm time in patients with acute stroke: sub-study of the preventive antibiotics in stroke study. BMC Neurol 2016; 16:241. [PMID: 27884126 PMCID: PMC5123223 DOI: 10.1186/s12883-016-0749-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 11/10/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients with acute stroke often do not seek immediate medical help, which is assumed to be driven by lack of knowledge of stroke symptoms. We explored the process of help seeking behavior in patients with acute stroke, evaluating knowledge about stroke symptoms, socio-demographic and clinical characteristics, and onset-to-alarm time (OAT). METHODS In a sub-study of the Preventive Antibiotics in Stroke Study (PASS), 161 acute stroke patients were prospectively included in 3 Dutch hospitals. A semi-structured questionnaire was used to assess knowledge, recognition and interpretation of stroke symptoms. With in-depth interviews, response actions and reasons were explored. OAT was recorded and associations with socio-demographic, clinical parameters were assessed. RESULTS Knowledge about stroke symptoms does not always result in correct recognition of own stroke symptoms, neither into correct interpretation of the situation and subsequent action. In our study population of 161 patients with acute stroke, median OAT was 30 min (interquartile range [IQR] 10-150 min). Recognition of one-sided weakness and/or sensory loss (p = 0.046) and adequate interpretation of the stroke situation (p = 0.003), stroke at daytime (p = 0.002), severe stroke (p = 0.003), calling the emergency telephone number (p = 0.004), and transport by ambulance (p = 0.040) were associated with shorter OAT. CONCLUSION Help seeking behavior after acute stroke is a complex process. A shorter OAT after stroke is associated with correct recognition of one-sided weakness and/or sensory loss, adequate interpretation of the stroke situation by the patient and stroke characteristics and logistics of stroke care, but not by knowledge of stroke symptoms.
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Affiliation(s)
- E. Zock
- Department of Neurology, Albert Schweitzer Hospital Dordrecht, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
- Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - H. Kerkhoff
- Department of Neurology, Albert Schweitzer Hospital Dordrecht, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
| | - R. P. Kleyweg
- Department of Neurology, Albert Schweitzer Hospital Dordrecht, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
| | | | - S. Scott
- Department of Neurology, Slotervaart Hospital Amsterdam, Amsterdam, The Netherlands
| | - N. D. Kruyt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - P. J. Nederkoorn
- Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - D. van de Beek
- Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
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Guillon B, Bourcier R, Toulgoat F, de Gaalon S, Gaultier-Lintia A, Sévin M. Gestione dell’infarto cerebrale acuto. Neurologia 2016. [DOI: 10.1016/s1634-7072(16)80382-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Muñoz Venturelli P, Robinson T, Lavados PM, Olavarría VV, Arima H, Billot L, Hackett ML, Lim JY, Middleton S, Pontes-Neto O, Peng B, Cui L, Song L, Mead G, Watkins C, Lin RT, Lee TH, Pandian J, de Silva HA, Anderson CS. Regional variation in acute stroke care organisation. J Neurol Sci 2016; 371:126-130. [PMID: 27871433 DOI: 10.1016/j.jns.2016.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/21/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST). METHODS HeadPoST is an on-going international multicenter crossover cluster-randomized trial of 'sitting-up' versus 'lying-flat' head positioning in acute stroke. As part of the start-up phase, one stroke care organisation questionnaire was completed at each hospital. The World Bank gross national income per capita criteria were used for classification. RESULTS 94 hospitals from 9 countries completed the questionnaire, 51 corresponding to MIC and 43 to HIC. Most participating hospitals had a dedicated stroke care unit/ward, with access to diagnostic services and expert stroke physicians, and offering intravenous thrombolysis. There was no difference for the presence of a dedicated multidisciplinary stroke team, although greater access to a broad spectrum of rehabilitation therapists in HIC compared to MIC hospitals was observed. Significantly more patients arrived within a 4-h window of symptoms onset in HIC hospitals (41 vs. 13%; P<0.001), and a significantly higher proportion of acute ischemic stroke patients received intravenous thrombolysis (10 vs. 5%; P=0.002) compared to MIC hospitals. CONCLUSIONS Although all hospitals provided advanced care for people with stroke, differences were found in stroke care organisation and treatment. Future multilevel analyses aims to determine the influence of specific organisational factors on patient outcomes.
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Affiliation(s)
- Paula Muñoz Venturelli
- The George Institute for Global Health, University of Sydney, Sydney, Australia; Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Thompson Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Disease, University of Leicester, Leicester, UK
| | - Pablo M Lavados
- Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Verónica V Olavarría
- Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Laurent Billot
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Maree L Hackett
- The George Institute for Global Health, University of Sydney, Sydney, Australia; College of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Joyce Y Lim
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincents Health Australia (Sydney) and Australian Catholic University, Australia
| | - Octavio Pontes-Neto
- Stroke Service, Neurology Division, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Lily Song
- Department of Neurology, Shanghai 85th Hospital of PLA, Shanghai, China
| | - Gillian Mead
- Department of Geriatric Medicine, Centre for Clinical Brain Sciences, University of Edinburgh, Scotland, UK
| | - Caroline Watkins
- College of Health and Wellbeing, University of Central Lancashire, Preston, UK; Nursing Research Institute, St Vincents Health Australia (Sydney) and Australian Catholic University, Australia
| | - Ruey-Tay Lin
- Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Taiwan
| | - Tsong-Hai Lee
- Department of Neurology, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - H Asita de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Craig S Anderson
- The George Institute for Global Health, University of Sydney, Sydney, Australia; Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia; The George Institute, China, Peking University Health Sciences Center, Beijing, China.
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Puolakka T, Strbian D, Harve H, Kuisma M, Lindsberg PJ. Prehospital Phase of the Stroke Chain of Survival: A Prospective Observational Study. J Am Heart Assoc 2016; 5:e002808. [PMID: 27139735 PMCID: PMC4889170 DOI: 10.1161/jaha.115.002808] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/03/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few studies have discussed the emergency call and prehospital care as a continuous process to decrease the prehospital and in-hospital delays for acute stroke. To identify features associated with early hospital arrival (<90 minutes) and treatment (<120 minutes), we analyzed the operation of current dispatch protocol and emergency medical services and compared stroke recognition by dispatchers and ambulance crews. METHODS AND RESULTS This was a 2-year prospective observational study. All stroke patients who were transported to the hospital by emergency medical services and received recanalization therapy were recruited for the study. For a sample of 308 patients, the stroke code was activated in 206 (67%) and high priority was used in 258 (84%) of the emergency calls. Emergency medical services transported 285 (93%) of the patients using the stroke code and 269 (87%) using high priority. In the univariate analysis, the most dominant predictors of early hospital arrival were transport using stroke code (P=0.001) and high priority (P=0.002) and onset-to-call (P<0.0001) and on-scene times (P=0.052). In the regression analysis, the influences of high-priority transport (P<0.01) and onset-to-call time (P<0.001) prevailed as significant in both dichotomies of early arrival and treatment. The on-scene time was found to be surprisingly long (>23.5 minutes) for both early and late-arriving patients. CONCLUSIONS Fast emergency medical services activation and ambulance transport promoted early hospital arrival and treatment. Although patient-dependent delays still dominate the prehospital process, it should be ensured that the minutes on the scene are well spent.
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Affiliation(s)
- Tuukka Puolakka
- Emergency Medical Services, Helsinki University Hospital, Helsinki, Finland
| | - Daniel Strbian
- Department of Neurology and Clinical Neurosciences, Helsinki University Hospital, Helsinki, Finland
| | - Heini Harve
- Emergency Medical Services, Helsinki University Hospital, Helsinki, Finland
| | - Markku Kuisma
- Emergency Medical Services, Helsinki University Hospital, Helsinki, Finland
| | - Perttu J Lindsberg
- Department of Neurology and Clinical Neurosciences, Helsinki University Hospital, Helsinki, Finland Research Programs Unit, Molecular Neurology, Biomedicum Helsinki, University of Helsinki, Finland
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Zhou Y, Yang T, Gong Y, Li W, Chen Y, Li J, Wang M, Yin X, Hu B, Lu Z. Pre-hospital Delay after Acute Ischemic Stroke in Central Urban China: Prevalence and Risk Factors. Mol Neurobiol 2016; 54:3007-3016. [PMID: 27032390 DOI: 10.1007/s12035-016-9750-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 01/26/2016] [Indexed: 11/24/2022]
Abstract
Timely thrombolytic treatment is paramount after acute ischemic stroke (AIS); however, a large proportion of patients experience substantial delays in presentation to hospital. This study evaluates the prevalence and risk factors in pre-hospital delays after AIS in central urban China. AIS patients from 66 hospitals in 13 major cities across Hubei Province, between October 1, 2014 and January 31, 2015 were interviewed and their medical records were reviewed to identify those who suffered pre-hospital delays. Bivariate and multivariate analyses were undertaken to determine the prevalence rates and the risk factors associated with pre-hospital delays. A total of 1835 patients were included in the analysis, with 69.3 % patients reportedly arrived at hospital 3 or more hours after onset and 55.3 % patients arrived 6 or more hours after onset. Factors associated with increased pre-hospital delays for 3 or more hours were as follows: patient had a history of stroke (odds ratio (OR), 1.319, P = 0.028), onset location was at home (OR, 1.573, P = 0.002), and patients rather than someone else noticed the symptom onset first (OR, 1.711; P < 0.001). In contrast, knowing someone who had suffered a stroke, considering any kind of the symptoms as severe, transferring from a community-based hospital factors, calling emergency number (120), and shorter distance from the onset place to the first hospital were independently associated with decreased pre-hospital delays. These findings indicate that pre-hospital delays after AIS are common in urban central China, and future intervention programs should be focused on public awareness of stroke and appropriate response.
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Affiliation(s)
- Yanfeng Zhou
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tingting Yang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wenzhen Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yawen Chen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jing Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Mengdie Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- The Stroke Quality Control Center of Hubei Province, Wuhan, 430030, China.
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Mellon L, Doyle F, Williams D, Brewer L, Hall P, Hickey A. Patient behaviour at the time of stroke onset: a cross-sectional survey of patient response to stroke symptoms. Emerg Med J 2016; 33:396-402. [PMID: 26781460 DOI: 10.1136/emermed-2015-204806] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 12/22/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Revascularisation treatment with thrombolysis must be initiated within 4.5 h following ischaemic stroke symptom onset. Despite its proven benefits, thrombolysis therapy is underused, with patient delay in presenting to hospital with symptoms identified as the leading barrier. This study aimed to examine help-seeking behaviour at stroke onset, in order to understand delays in accessing acute medical care for stroke symptoms. METHODS 149 consecutive patients hospitalised with ischaemic stroke were interviewed at 72 h poststroke with the Stroke Awareness Questionnaire and the Response to Symptoms Questionnaire. RESULTS Sixty per cent of stroke cases presented to the ED within 3.5 h of stroke onset. Knowledge of stroke symptoms and risk factors was poor, with 40% unable to correctly define a stroke. Bystander recognition of symptoms (p=0.03) and bystander initiation of Emergency Medical Services was associated with ED presentation within 3.5 h (p=0.03). CONCLUSIONS This study provides insights into patient response when a stroke occurs, with the presence and action of others highlighted as critical in fast response to stroke symptoms. Knowledge of stroke warning signs and risk factors was low among stroke survivors. Findings highlight the complexity of changing help-seeking behaviour during stroke onset, and provide directions for public education efforts to reduce prehospital delay.
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Affiliation(s)
- L Mellon
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - F Doyle
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - L Brewer
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P Hall
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Doggen CJM, Zwerink M, Droste HM, Brouwers PJAM, van Houwelingen GK, van Eenennaam FL, Egberink RE. Prehospital paths and hospital arrival time of patients with acute coronary syndrome or stroke, a prospective observational study. BMC Emerg Med 2016; 16:3. [PMID: 26748628 PMCID: PMC4706997 DOI: 10.1186/s12873-015-0065-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 12/07/2015] [Indexed: 12/04/2022] Open
Abstract
Background Patients with a presumed diagnosis of acute coronary syndrome (ACS) or stroke may have had contact with several healthcare providers prior to hospital arrival. The aim of this study was to describe the various prehospital paths and the effect on time delays of patients with ACS or stroke. Methods This prospective observational study included patients with presumed ACS or stroke who may choose to contact four different types of health care providers. Questionnaires were completed by patients, general practitioners (GP), GP cooperatives, ambulance services and emergency departments (ED). Additional data were retrieved from hospital registries. Results Two hundred two ACS patients arrived at the hospital by 15 different paths and 243 stroke patients by ten different paths. Often several healthcare providers were involved (60.8 % ACS, 95.1 % stroke). Almost half of all patients first contacted their GP (47.5 % ACS, 49.4 % stroke). Some prehospital paths were more frequently used, e.g. GP (cooperative) and ambulance in ACS, and GP or ambulance and ED in stroke. In 65 % of all events an ambulance was involved. Median time between start of symptoms and hospital arrival for ACS patients was over 6 h and for stroke patients 4 h. Of ACS patients 47.7 % waited more than 4 h before seeking medical advice compared to 31.6 % of stroke patients. Median time between seeking medical advice to arrival at hospital was shortest in paths involving the ambulance only (60 min ACS, 54 min stroke) or in combination with another healthcare provider (80 to 100 min ACS, 99 to 106 min stroke). Conclusions Prehospital paths through which patients arrived in hospital are numerous and often complex, and various time delays occurred. Delays depend on the entry point of the health care system, and dialing the emergency number seems to be the best choice. Since reducing patient delay is difficult and noticeable differences exist between various prehospital paths, further research into reasons for these different entry choices may yield possibilities to optimize paths and reduce overall time delay.
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Affiliation(s)
- Carine J M Doggen
- Department of Health Technology and Services Research (HTSR), MIRA institute for Biomedical Technology and Technical Medicine, University of Twente, RA 5252, PO Box 217, 7500, AE, Enschede, The Netherlands.
| | - Marlies Zwerink
- Department of Health Technology and Services Research (HTSR), MIRA institute for Biomedical Technology and Technical Medicine, University of Twente, RA 5252, PO Box 217, 7500, AE, Enschede, The Netherlands.
| | - Hanneke M Droste
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Paul J A M Brouwers
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Gert K van Houwelingen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.
| | | | - Rolf E Egberink
- Department of Health Technology and Services Research (HTSR), MIRA institute for Biomedical Technology and Technical Medicine, University of Twente, RA 5252, PO Box 217, 7500, AE, Enschede, The Netherlands. .,Regional Network for Emergency Care, Acute Zorg Euregio, Enschede, The Netherlands.
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Marto JP, Borbinha C, Filipe R, Calado S, Viana-Baptista M. Impact of stroke education on middle school students and their parents: A cluster randomized trial. Int J Stroke 2016; 12:401-411. [PMID: 27799456 DOI: 10.1177/1747493016677980] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background School students are an attractive target for stroke education due to the potential impact on stroke prevention and recognition. Additionally, these students can drive behavioral changes in their families. Aim To evaluate the impact of stroke education on school students, in terms of students' and parents' acquired stroke knowledge. Methods A structured questionnaire on knowledge of stroke was filled out by eighth-grade students and one of their parents in seven public schools. In four of these schools, students attended a stroke lecture; educational flyers and magnetic posters were distributed and parent education was encouraged. Students and parents of the other three schools were included in a control group. Students and parents, of both intervention and control groups, were resubmitted to the initial structured questionnaire within one week of the stroke lecture and three months later. Results We included 764 students and 344 parents, 383 (50.1%) and 210 (61.0%) in the intervention group. Correct test scores for students before, within one week, and three months after the intervention were 54.49% versus 55.03% (p = 0.418), 98.69% versus 60.89% (p < 0.001), and 95.58% versus 75.7% (p < 0.001) in the intervention and control groups, respectively. Correct test scores for parents at the same time points were 68.78% versus 64.47% (p = 0.107), 96.89% versus 71.42% (p < 0.001), and 94.58% versus 76.54% (p < 0.001) in the intervention and control groups, respectively. Conclusions School-based interventions may improve stroke knowledge in middle school students and their parents.
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Affiliation(s)
- João Pedro Marto
- 1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Cláudia Borbinha
- 1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Rita Filipe
- 2 Public Health Unit, Agrupamento de Centros de Saúde (ACES), Lisboa Ocidental e Oeiras, Lisbon, Portugal
| | - Sofia Calado
- 1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.,3 Chronic Diseases Research Centre (CEDOC)-Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Miguel Viana-Baptista
- 1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.,3 Chronic Diseases Research Centre (CEDOC)-Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
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Lau AHT, Hall G, Scott IA, Williams M. Thrombolysis in acute stroke: ongoing challenges based on a tertiary hospital audit and comparisons with other Australian studies. AUST HEALTH REV 2016; 40:43-53. [DOI: 10.1071/ah14167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 04/20/2015] [Indexed: 11/23/2022]
Abstract
Objective Intravenous thrombolysis with tissue plasminogen activator (tPA) improves patient outcomes in acute ischaemic stroke. Because its benefit is time-dependant, treatment delays must be minimised. The aim of the present study was to review patient characteristics, timeliness of tPA delivery and clinical outcome in patients receiving t-PA in a tertiary hospital stroke unit in Queensland, and to compare the findings with those of other Australian studies. Methods The present study was a retrospective study conducted between 1 January 2010 and 31 December 2012. Information was collected regarding demographics, stroke characteristics, timeliness of tPA delivery, clinical outcome, safety outcome and protocol deviation. Results Of 490 patients admitted with ischaemic stroke, 57 (11.6%) received tPA. Compared with other studies, the patients in the present study had more severe stroke (median National Institutes of Health Stroke Scale (NIHSS) score), more cardioembolic strokes and more patients receiving tPA between 3 and 4.5 h of symptoms onset. Median symptom onset to treatment time was 175 min and median door to needle time was 97 min. At 3 months, 21.1% of patients had died and 41.5% had a favourable outcome (modified Rankin scale ≤2). Symptomatic intracerebral haemorrhage occurred in 5.3% of patients and protocol deviations occurred in 21.1%. Overall, delivery and outcomes of tPA at the Princess Alexandra Hospital were comparable to those reported in other Australian studies of usual care. Several challenges and strategies for optimal thrombolysis were identified, with supporting evidence from selected Australian sites. Conclusion The proportion of eligible stroke patients who receive tPA in a timely manner remains less than ideal at our centre. More accurate patient selection and reductions in treatment delays serve as targets for quality improvement efforts that have broad applicability. What is known about the topic? Stroke unit care and tPA thrombolysis are two proven strategies to improve outcome in patients with ischaemic stroke. Although the stroke unit is gaining momentum of growth in Australia (especially in Queensland), little improvement has been achieved in thrombolysis rate and timeliness of treatment delivery, and little is known about the service delivery in Queensland because there are no published data. What does this paper add? This paper provides an extensive review of thrombolysis treatment in a tertiary Queensland hospital, adding to the understanding of treatment implementation. It also provides a complete and comprehensive review of treatment delay (including emergency department referral time and computed tomography to needle time, which have not been reported in other Australian studies), and a template for data collection to review treatment delay and outcome measurement in detail. It also compares findings with peer Australian studies (this has not been reported previously) and summarises potential strategies that could be adopted systemically. What are the implications for practitioners? Delivery of thrombolysis treatment in a timely manner remains a significant challenge to stroke physicians. All stroke units are encouraged to prospectively collect thrombolysis data in the format adopted in the present study for purposes of peer comparisons and shared learning.
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Seo M, Begley C, Langabeer JR, DelliFraine JL. Barriers and disparities in emergency medical services 911 calls for stroke symptoms in the United States adult population: 2009 BRFSS Survey. West J Emerg Med 2015; 15:251-9. [PMID: 24926394 PMCID: PMC4043558 DOI: 10.5811/westjem.2013.9.18584] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 09/09/2013] [Accepted: 09/09/2013] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION This study examines barriers and disparities in the intentions of American citizens, when dealing with stroke symptoms, to call 911. This study hypothesizes that low socioeconomic populations are less likely to call 911 in response to stroke recognition. METHODS The study is a cross-sectional design analyzing data from the Centers for Disease Control's 2009 Behavioral Risk Factor Surveillance Survey, collected through a telephone-based survey from 18 states and the District of Columbia. The study identified the 5 most evident stroke-warning symptoms based on those given by the American Stroke Association. We conducted appropriate weighting procedures to account for the complex survey design. RESULTS A total of 131,988 respondents answered the following question: "If you thought someone was having a heart attack or a stroke, what is the first thing you would do?" A majority of those who said they would call 911 were insured (85.1%), had good health (84.1%), had no stroke history (97.3%), had a primary care physician (PCP) (81.4%), and had no burden of medical costs (84.9%). Those less likely to call 911 were found in the following groups: 65 years or older, men, other race, unmarried, less than or equal to high school degree, less than $25,000 family income, uninsured, no PCP, burden of medical costs, fair/poor health, previous history of strokes, or interaction between burden of medical costs and less than $50,000 family income (p<0.0001 by X(2) tests). The only factors significantly associated with "would call 911" were age, sex, race/ethnicity, marital status, and previous history of strokes. CONCLUSION Barriers and disparities exist among subpopulations of different socioeconomic statuses. This study suggests that some potential stroke victims could have limited access to EMS services. Greater effort targeting certain populations is needed to motivate citizens to call 911.
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Affiliation(s)
- Munseok Seo
- Management, Policy and Community Health Division, University of Texas Health Science Center, Houston, Texas
| | - Charles Begley
- Management, Policy and Community Health Division, University of Texas Health Science Center, Houston, Texas
| | - James R Langabeer
- Management, Policy and Community Health Division, University of Texas Health Science Center, Houston, Texas
| | - Jami L DelliFraine
- Virginia Commonwealth University, Department of Health Administration, Richmond, Virginia
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Wireklint Sundström B, Herlitz J, Hansson PO, Brink P. Comparison of the university hospital and county hospitals in western Sweden to identify potential weak links in the early chain of care for acute stroke: results of an observational study. BMJ Open 2015; 5:e008228. [PMID: 26351184 PMCID: PMC4563274 DOI: 10.1136/bmjopen-2015-008228] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To identify weak links in the early chain of care for acute stroke. SETTING 9 emergency hospitals in western Sweden, each with a stroke unit, and the emergency medical services (EMS). PARTICIPANTS All patients hospitalised with a first and a final diagnosis of stroke-between 15 December 2010 and 15 April 2011. The university hospital in the city of Gothenburg was compared with 6 county hospitals. PRIMARY AND SECONDARY MEASURES: (1) The system delay, that is, median delay time from call to the EMS until diagnosis was designated as the primary end point. Secondary end points were: (2) the system delay time from call to the EMS until arrival in a hospital ward, (3) the use of the EMS, (4) priority at the dispatch centre and (5) suspicion of stroke by the EMS nurse. RESULTS In all, 1376 acute patients with stroke (median age 79 years; 49% women) were included. The median system delay from call to the EMS until (1) diagnosis (CT scan) and (2) arrival in a hospital ward was 3 h and 52 min and 4 h and 22 min, respectively. The system delay (1) was significantly shorter in county hospitals. (3) The study showed that 76% used the EMS (Gothenburg 71%; the county 79%; p<0.0001). (4) Priority 1 was given at the dispatch centre in 54% of cases. (5) Stroke was suspected in 65% of cases. A prenotification was sent in 32% (Gothenburg 52%; the county 20%; p<0.0001). CONCLUSIONS System delay is still long and only a small fraction of patients received thrombolysis. Three of four used the EMS (more frequent in the county). They were given the highest priority at the dispatch centre in half of the cases. Stroke was suspected in two-thirds of the cases, but a prenotification was seldom sent to the hospital.
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Affiliation(s)
- Birgitta Wireklint Sundström
- Faculty of Caring Science, Work Life and Social Welfare, Research Centre PreHospen, University of Borås, The Prehospital Research Centre of Western Sweden, Borås, Sweden
| | - Johan Herlitz
- Faculty of Caring Science, Work Life and Social Welfare, Research Centre PreHospen, University of Borås, The Prehospital Research Centre of Western Sweden, Borås, Sweden
| | - Per Olof Hansson
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Peter Brink
- Emergency Medical Service System, NU-Hospital Organisation,Trollhättan, Sweden
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Mochari-Greenberger H, Xian Y, Hellkamp AS, Schulte PJ, Bhatt DL, Fonarow GC, Saver JL, Reeves MJ, Schwamm LH, Smith EE. Racial/Ethnic and Sex Differences in Emergency Medical Services Transport Among Hospitalized US Stroke Patients: Analysis of the National Get With The Guidelines-Stroke Registry. J Am Heart Assoc 2015; 4:e002099. [PMID: 26268882 PMCID: PMC4599467 DOI: 10.1161/jaha.115.002099] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Differences in activation of emergency medical services (EMS) may contribute to racial/ethnic and sex disparities in stroke outcomes. The purpose of this study was to determine whether EMS use varied by race/ethnicity and sex among a current, diverse national sample of hospitalized acute stroke patients. METHODS AND RESULTS We analyzed data from 398,798 stroke patients admitted to 1613 Get With The Guidelines-Stroke participating hospitals between October 2011 and March 2014. Multivariable logistic regression was used to evaluate the associations between combinations of racial/ethnic and sex groups with EMS use, adjusting for potential confounders including demographics, medical history, and stroke symptoms. Patients were 50% female, 69% white, 19% black, 8% Hispanic, 3% Asian, and 1% other, and 86% had ischemic stroke. Overall, 59% of stroke patients were transported to the hospital by EMS. White women were most likely to use EMS (62%); Hispanic men were least likely to use EMS (52%). After adjustment for patient characteristics, Hispanic and Asian men and women had 20% to 29% lower adjusted odds of using EMS versus their white counterparts; black women were less likely than white women to use EMS (odds ratio 0.75, 95% CI 0.72 to 0.77). Patients with weakness or paresis, altered level of consciousness, and/or aphasia were significantly more likely to use EMS than patients without each symptom; the observed racial/ethnic and sex differences in EMS use remained significant after adjustment for stroke symptoms. CONCLUSIONS EMS use differed by race/ethnicity and sex. These contemporary data document suboptimal use of EMS transport among US stroke patients, especially by racial/ethnic minorities and those with less recognized stroke symptoms.
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Affiliation(s)
| | - Ying Xian
- Duke Clinical Research Institute, Durham, NC (Y.X., A.S.H., P.J.S.)
| | - Anne S Hellkamp
- Duke Clinical Research Institute, Durham, NC (Y.X., A.S.H., P.J.S.)
| | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Gregg C Fonarow
- David Geffen School of Medicine, University of California at Los Angeles, CA (G.C.F., J.L.S.)
| | - Jeffrey L Saver
- David Geffen School of Medicine, University of California at Los Angeles, CA (G.C.F., J.L.S.)
| | | | | | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.)
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Berglund A, Heikkilä K, Bohm K, Schenck-Gustafsson K, von Euler M. Factors facilitating or hampering nurses identification of stroke in emergency calls. J Adv Nurs 2015; 71:2609-21. [PMID: 26183379 DOI: 10.1111/jan.12729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 11/26/2022]
Abstract
AIMS To explore the factors that facilitate or hamper identification of stroke in emergency calls concerning patients with stroke who have fallen or been in a lying position. BACKGROUND Early identification of stroke in emergency calls is vital but can be complicated as the patients may be unable to express themselves and the callers generally are bystanders. In a previous study, we found presentation of fall or the patient being in a lying position to be the major problem in 66% of emergency calls concerning, but not dispatched as acute stroke. DESIGN A qualitative study using interpretive phenomenology. METHODS Analysis of transcribed emergency calls concerning 29 patients with stroke diagnoses at hospital discharge, in 2011 and presented with fall/lying position. FINDINGS Patients' ability to express themselves, callers' knowledge of the patient and of stroke, first call-takers' and nurses' authority, nurses' coaching and nurses' expertise skills facilitated or hindered the identification of stroke. Certain aspects are adjustable, but some are determined by the situation or on callers' and patients' abilities and thus difficult to change. Nurses' expertise skills were the only theme found to have a decisive effect of the identification of stroke on its own. CONCLUSION To increase identification of stroke in emergency calls concerning stroke, the first call-takers' and nurses' action, competence and awareness of obstacles are crucial and if strengthened would likely increase the identification of stroke in emergency calls. In complicated cases, nurses' expertise skills seem essential for identification of stroke.
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Affiliation(s)
- Annika Berglund
- Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Karolinska Institutet, Center for Gender Medicine, Stockholm, Sweden
| | - Kristiina Heikkilä
- Department of Health and Caring Sciences, Linneaus University, Kalmar, Sweden
| | - Katarina Bohm
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Karin Schenck-Gustafsson
- Karolinska Institutet, Center for Gender Medicine, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mia von Euler
- Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Karolinska Institutet, Center for Gender Medicine, Stockholm, Sweden
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Abstract
There has been a tremendous evolution in the stroke systems of care in the USA. Public awareness, prehospital care, and in-hospital protocols have never been so effectively connected. However, given the critical role of time to effective reperfusion in the setting of acute ischemic stroke, it is vital and timely to implement strategies to further streamline emergency stroke care. This article reviews the most current standards and guidelines related to the flow of stroke care in the prehospital and emergency settings.
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Affiliation(s)
- Keith G DeSousa
- Department of Neurology, University of Miami Miller School of Medicine, 1120 NW 14th St, CRB 13th Floor, Miami, FL, 33136, USA,
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Bray JE, Straney L, Barger B, Finn J. Effect of Public Awareness Campaigns on Calls to Ambulance Across Australia. Stroke 2015; 46:1377-80. [DOI: 10.1161/strokeaha.114.008515] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/23/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The National Stroke Foundation of Australia has run 12 public awareness campaigns since 2004. Campaign exposure and funding has varied annually and regionally during this time. The aim of this study was to measure the effect of campaigns on calls to ambulance for stroke across Australia in exposed regions (paid or pro bono advertising).
Methods—
All ambulance services in Australia provided monthly ambulance dispatch data between January 2003 and June 2014. We performed multivariable regression to measure the effect of campaign exposure on the volume of stroke-related emergency calls, after controlling for confounders.
Results—
The final model indicated that 11 of the 12 National Stroke Foundation campaigns were associated with increases in the volume of stroke-related calls (varying between 1% and 9.9%) in regions with exposure to advertising. This increase lasted ≈3 months, with an additional 10.2% relative increase in the volume of the calls in regions with paid advertising. We found no significant additional effect of the campaigns on stroke calls where ambulance services are publicly funded.
Conclusions—
The National Stroke Foundation stroke awareness campaigns are associated with increases to calls to ambulance for stroke in regions receiving advertising and promotion. Research is now required to examine whether this increased use in ambulance is for appropriate emergencies.
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Affiliation(s)
- Janet E. Bray
- From the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.B., L.S., J.F.); Alfred Hospital, Melbourne, Victoria, Australia (J.E.B.); Curtin University, Perth, Western Australia, Australia (J.E.B., J.F.); Ambulance Victoria, Melbourne, Victoria, Australia (B.B.); and St John Ambulance, Perth, Western Australia, Australia (J.F.)
| | - Lahn Straney
- From the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.B., L.S., J.F.); Alfred Hospital, Melbourne, Victoria, Australia (J.E.B.); Curtin University, Perth, Western Australia, Australia (J.E.B., J.F.); Ambulance Victoria, Melbourne, Victoria, Australia (B.B.); and St John Ambulance, Perth, Western Australia, Australia (J.F.)
| | - Bill Barger
- From the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.B., L.S., J.F.); Alfred Hospital, Melbourne, Victoria, Australia (J.E.B.); Curtin University, Perth, Western Australia, Australia (J.E.B., J.F.); Ambulance Victoria, Melbourne, Victoria, Australia (B.B.); and St John Ambulance, Perth, Western Australia, Australia (J.F.)
| | - Judith Finn
- From the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.B., L.S., J.F.); Alfred Hospital, Melbourne, Victoria, Australia (J.E.B.); Curtin University, Perth, Western Australia, Australia (J.E.B., J.F.); Ambulance Victoria, Melbourne, Victoria, Australia (B.B.); and St John Ambulance, Perth, Western Australia, Australia (J.F.)
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Berglund A, von Euler M, Schenck-Gustafsson K, Castrén M, Bohm K. Identification of stroke during the emergency call: a descriptive study of callers' presentation of stroke. BMJ Open 2015; 5:e007661. [PMID: 25922106 PMCID: PMC4420966 DOI: 10.1136/bmjopen-2015-007661] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate symptoms presented by the caller during emergency calls regarding stroke, and to assess if symptoms in the Face-Arm-Speech-Time Test (FAST) are related to identification of stroke. SETTING Emergency calls to the Emergency Medical Communication Center (EMCC) concerning patients discharged with stroke diagnosis in a large teaching hospital in Stockholm, Sweden, in January-June 2011. PARTICIPANTS The emergency calls of 179 patients who arrived at hospital by ambulance, and who were discharged with a stroke diagnosis and consented to participate were included in the study. OUTCOME MEASURES Frequencies of stroke symptoms presented and a comparison of symptoms presented in calls with dispatch code stroke or other dispatch code. RESULTS Of the 179 emergency calls analysed, 64% were dispatched as 'Stroke'. FAST symptoms, that is, facial or arm weakness or speech disturbances, were presented in 64% of the calls and were spontaneously revealed in 90%. Speech disturbance was the most common problem (54%) in all calls, followed by fall/lying position (38%) and altered mental status (27%). For patients with dispatch codes other than stroke, the dominating problem presented was a fall or being in a lying position (66%), followed by speech disturbance (31%) and altered mental status (25%). Stroke-specific symptoms were more common in patients dispatched as stroke. FAST symptoms were reported in 80% of patients dispatched as stroke compared with 35% in those dispatched as something else. CONCLUSIONS This study implicates that fall/lying position and altered mental status could be considered as possible symptoms of stroke during an emergency call. Checking for FAST symptoms in these patients might uncover stroke symptoms. Future studies are needed to evaluate if actively asking for FAST symptoms in emergency calls presenting falls or a lying position can improve the identification of stroke. TRIAL REGISTRATION NUMBER Stroke2010/703-31/2.
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Affiliation(s)
- Annika Berglund
- Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Section of Neurology, Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
- Karolinska Institutet, Center for Gender Medicine, Stockholm, Sweden
| | - Mia von Euler
- Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Section of Neurology, Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
- Karolinska Institutet, Center for Gender Medicine, Stockholm, Sweden
| | - Karin Schenck-Gustafsson
- Karolinska Institutet, Center for Gender Medicine, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maaret Castrén
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Katarina Bohm
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden
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