Analysis of Stroke Care Among 2019-2020 National Emergency Medical Services Information System Encounters

Dylla, Layne; Rice, John D.; Poisson, Sharon N.; Monte, Andrew A.; Higgins, Hannah M.; Ginde, Adit A.; Herson, Paco S.

doi:10.1016/j.jstrokecerebrovasdis.2021.106278

Cited by 5 publications

(6 citation statements)

References 25 publications

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“…In contrast, DTN times differed less dramatically across EMS quality scores, but the trend was more linear. There was substantial variability across agency-hospital pairs in DTCT (median, 22 [IQR, ) and DTN times (median, 59 [39][40][41][42][43][44][45][46][47][48][49]; Figure S1). The results of multivariable regression models to assess associations between the summary EMS quality score and each outcome are presented in Table 4.…”

Section: Resultsmentioning

confidence: 99%

“…EMS compliance with individual quality metrics has been demonstrated to be inconsistent 39 and may be influenced by a variety of patient-level and system-level factors. 27 Therefore, a method to assess the overall quality of stroke-related care provided in the prehospital setting is desirable for benchmarking and monitoring quality improvement interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings lend support to current recommendations for prehospital stroke 14,26,38 as well as to the value of stroke scale documentation, currently endorsed as a quality measure by the National EMS Quality Alliance, 16 and the 4 performance measures utilized by the American Heart Association Mission: lifeline EMS recognition program (stroke scale documentation, prenotification, LKW documentation, and glucose check). 17 EMS compliance with individual quality metrics has been demonstrated to be inconsistent 39 and may be influenced by a variety of patient-level and system-level factors. 27 Therefore, a method to assess the overall quality of stroke-related care provided in the prehospital setting is desirable for benchmarking and monitoring quality improvement interventions.…”

Section: Discussionmentioning

confidence: 99%

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Emergency Medical Services Compliance With Prehospital Stroke Quality Metrics Is Associated With Faster Stroke Evaluation and Treatment

Oostema,

Nickles,

Allen

et al. 2024

Stroke

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BACKGROUND: Emergency medical services (EMS) is an important link in the stroke chain of recovery. Various prehospital quality metrics have been proposed for prehospital stroke care, but their individual impact is uncertain. We sought to measure associations between EMS quality metrics and downstream stroke care. METHODS: This is a retrospective analysis of a cohort of EMS-transported stroke patients assembled through a linkage between Michigan’s EMS and stroke registries. We used multivariable regression to quantify the independent associations between EMS quality metric compliance (dispatch within 90 seconds of 911 call, prehospital stroke screen documentation [Prehospital stroke scale], glucose check, last known well time, maintenance of scene times ≤15 minutes, hospital prenotification, and intravenous line placement) and shorter door-to-CT times (door-to-CT ≤25), accounting for EMS recognition, age, sex, race, stroke subtype, severity, and duration of symptoms. We then developed a simple EMS quality score based on metrics associated with early CT and examined its associations with hospital stroke evaluation times, treatment, and patient outcomes. RESULTS: Five thousand seven hundred seven EMS-transported stroke cases were linked to prehospital records from January 2018 through June 2019. In multivariable analysis, prehospital stroke scale documentation (adjusted odds ratio, 1.4 [1.2–1.6]), glucose check (1.3 [1.1–1.6]), on-scene time ≤15 minutes (1.6 [1.4–1.9]), hospital prenotification ([2.0 [1.4–2.9]), and intravenous line placement (1.8 [1.5–2.1]) were independently associated with a door-to-CT ≤25 minutes. A 5-point quality score (1 point for each element) was therefore developed. In multivariable analysis, a 1-point higher EMS quality score was associated with a shorter time from EMS contact to CT (−9.2 [−10.6 to −7.8] minutes; P <0.001) and thrombolysis (−4.3 [−6.4 to −2.2] minutes; P <0.001), and higher odds of discharge to home (adjusted odds ratio, 1.1 [1.0–1.2]; P =0.002). CONCLUSIONS: Five EMS actions recommended by national guidelines were associated with rapid CT imaging. A simple quality score derived from these measures was also associated with faster stroke evaluation, greater odds of reperfusion treatment, and discharge to home.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Emergency Medical Services Compliance With Prehospital Stroke Quality Metrics Is Associated With Faster Stroke Evaluation and Treatment

Oostema,

Nickles,

Allen

et al. 2024

Stroke

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“…25 Analyses suggest that few EMS encounters are fully concordant with guideline recommendations. 62 Hospital-directed feedback increases prehospital compliance with guideline-concordant care, including documentation of a prehospital stroke assessment and last known well time. 63 Unfortunately, such processes are uncommon and tend to be resource intensive.…”

Section: Structural Components In Prehospital Stroke Systems Of Care ...mentioning

confidence: 99%

Prehospital Stroke Care Part 1: Emergency Medical Services and the Stroke Systems of Care

Zachrison

Nielsen

Ossa

et al. 2023

Stroke

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Acute stroke care begins before hospital arrival, and several prehospital factors are critical in influencing overall patient care and poststroke outcomes. This topical review provides an overview of the state of the science on prehospital components of stroke systems of care and how emergency medical services systems may interact in the system to support acute stroke care. Topics include layperson recognition of stroke, prehospital transport strategies, networked stroke care, systems for data integration and real-time feedback, and inequities that exist within and among systems.

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“…Whereas, an ECG also used to detect coronary artery disease (CAD) and the acute coronary syndrome (ACS). 7 ECG has the capability to verify the presence of ST elevation myocardial Infarction, the localization of a STEMI leads to declaration of an emergency status in the need of the reperfusion therapy. These-condition usually requires a rapid transport to a hospital with the capability of performing primary PCI.…”

mentioning

confidence: 99%

Validation of interpretation of ST-elevation myocardial infarction using the smartphone based 12 lead electrocardiograms in comparison to the cardiologist-a cross sectional study, validation study, single-center study

Mahajan¹,

Garg²,

Sharma³

et al. 2023

Int J Clin Trials

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Background: In patients experiencing an ST-elevation myocardial infarction (STEMI), rapid diagnosis leads to optimal clinical outcomes. Recent technology has provided access to a reliable means of obtaining an ECG reading through a smartphone application (app) that works with an attachment providing all 12-leads of a standard ECG system. We developed a 12-lead smartphone-based electrocardiogram (ECG) called “Spandan”, and an application to accurately assess the presence of STEMI in patients presenting with chest pain. Objectives of study was to perform clinical observation studies on the patients screened for STEMIs and evaluate the variation in the diagnosis of STEMIs detected in both 12-lead gold standard and Spandan 12 lead ECG. Methods: This single-center study was carried out at Shri Mahant Indresh hospital (SMIH), Dehradun, Uttarakhand, India from April-2022 to November-2022. All patients (n=278) visiting the ECG room with symptoms of chest pain, shortness of breath and past history of cardiovascular disease at the department of cardiology of the SMIH, Dehradun were included in the study. Results: Mean age (SD) was 53.96±15.31 years. The male gender participants was 75.17%. 14.3% were STEMI patients as per the standard 12 lead interpretation, smartphone ECG interpreted 7.1% of the participants as STEMI and cardiologist interpreted nearly 15.4% of the participants of STEMI. Conclusions: This study confirmed the potential of a smartphone ECG for evaluation of STEMI and the feasibility of studying this technology further to define the diagnostic accuracy, limitations, and appropriate use of this new technology.

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Analysis of Stroke Care Among 2019-2020 National Emergency Medical Services Information System Encounters

Cited by 5 publications

References 25 publications

Emergency Medical Services Compliance With Prehospital Stroke Quality Metrics Is Associated With Faster Stroke Evaluation and Treatment

Emergency Medical Services Compliance With Prehospital Stroke Quality Metrics Is Associated With Faster Stroke Evaluation and Treatment

Prehospital Stroke Care Part 1: Emergency Medical Services and the Stroke Systems of Care

Validation of interpretation of ST-elevation myocardial infarction using the smartphone based 12 lead electrocardiograms in comparison to the cardiologist-a cross sectional study, validation study, single-center study

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