Comparison of prehospital stroke care at private homes and residential care settings

Abstract

Background: Suspected stroke is a common scenario among care home residents, who are typically older and have more complex health needs than the general population. Aims: The aim of this study was to describe the care of suspected stroke patients according to their residential status. Methods: Retrospective secondary analysis was carried out using a clinical record dataset from a UK ambulance service that described the care of patients labelled as having a suspected stroke between December 2021 and April 2022. Findings: Care home patients were older (median age 86 (interquartile range (IQR) 79–91) years) than those in their own homes (median age 75 (IQR 63–83) years; P≤0.001), with more comorbidities (median of five (IQR 3–6) versus median of three (IQR 2–5); P≤0.001) and taking more medications (median of six (IQR 4–9) versus median of four (IQR 1–7); P≤0.001). They were more likely to have difficulties completing the face, arms, speech, time test (17/170 (10%) versus 39/1305 (3%); P≤0.001) and present with facial droop (85/153 (55.6%) versus 506/1266 (40%); P≤0.001). Ambulance on-scene time was longer at care homes (median 41 (IQR 32–49.5) minutes versus median 35 (IQR 27–45) minutes; P≤0.001). Conclusion: Clinician awareness of characteristics associated with residential settings may be important for delivering emergency stroke care. Research is needed to optimise ambulance assessment for care home patients.