The clinical consequences of a pre-hospital diagnosis of stroke by the emergency medical service system. A pilot study

Wennman, Ingela; Klittermark, Paula; Herlitz, Johan; Lernfelt, Bodil; Kihlgren, M.; Gustafsson, Claes M.; Hansson, Per‐Olof

doi:10.1186/1757-7241-20-48

Cited by 17 publications

(16 citation statements)

References 15 publications

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“…The identification of a suspected acute stroke and TIA in the prehospital setting is an important yet challenging task. Previous studies have shown that between 30% and 45% of patients with a field diagnosis of stroke do not have the diagnosis confirmed at hospital . Several stroke recognition instrument tests have been introduced, and most of these tests include the three symptoms of facial weakness, arm weakness, and speech disturbance.…”

Section: Discussionmentioning

confidence: 99%

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Prehospital assessment of suspected stroke and TIA: An observational study

et al. 2019

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Background Symptoms related to stroke diverge and may mimic many other conditions. Aims To evaluate clinical findings among patients with a clinical suspicion of stroke in a prehospital setting and find independent predictors of a final diagnosis of stroke or transient ischemic attack (TIA). Methods An observational multicenter study includes nine emergency hospitals in western Sweden. All patients transported to hospital by ambulance and in whom a suspicion of stroke was raised by the emergency medical service clinician before hospital admission during a four‐month period were included. Results Of 1081 patients, a diagnosis of stroke was confirmed at hospital in 680 patients (63%), while 69 (6%) were diagnosed as TIA and 332 patients (31%) received other final diagnoses. In a multiple logistic regression analysis, factors independently associated with a final diagnosis of stroke or TIA were increasing age, odds ratio (OR) per year: 1.02, P = 0.007, a history of myocardial infarction (OR: 1.77, P = 0.01), facial droop (OR: 2.81, P < 0.0001), arm weakness (OR: 2.61, P < 0.0001), speech disturbance (OR: 1.92, P < 0.0001), and high systolic blood pressure (OR: 1.50, P = 0.02), while low oxygen saturation was significantly associated with other diagnoses (OR: 0.41, P = 0.007). More than half of all patients among patients with both stroke/TIA and other final diagnoses died during the five‐year follow‐up. Conclusions Seven factors including the three symptoms included in the Face Arm Speech Test were significantly associated with a final diagnosis of stroke or TIA in a prehospital assessment of patients with a suspected stroke.

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Section: Discussionmentioning

confidence: 99%

“…This includes the dispatch center and the emergency medical service (EMS). The link dealing with the EMS is dependent on the early identification of stroke by the EMS clinician . Stroke is characterized by the sudden loss of cerebral function, and there are a variety of symptoms in acute stroke, such as hemiparesis or aphasia.…”

Section: Introductionmentioning

confidence: 99%

Prehospital assessment of suspected stroke and TIA: An observational study

et al. 2019

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“…Since EDs cannot have any influence on the external factors of ED crowding, the focus should be more on internal factors, including their organisational and professional patterns. Amongst many suggestions in the literature, fast‐track and flexible‐care areas have gained popularity because of positive outcomes . Another approach with good global outcomes is the introduction of walk‐in centres and co‐located GPs, which have resulted in lower waits time compared with EDs without a GP .…”

Section: Discussionmentioning

confidence: 99%

“…Amongst many suggestions in the literature, fast-track and flexiblecare areas have gained popularity because of positive outcomes. 13,41 Another approach with good global outcomes is the introduction of walk-in centres and co-located GPs, 41 which have resulted in lower waits time compared with EDs without a GP. 42 The impact of GP-led walk-in centres on demand for ED care was studied in a British report, showing a significant reduction of 8.3% in GP-type presentations to adult EDs.…”

Section: Discussionmentioning

confidence: 99%

Urgent care centre in Sweden—the integration of teams and perceived effects

Wennman

Wittholt

Carlström

et al. 2019

Health Planning & Management

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Summary An urgent care centre (UCC) is an upcoming trend in Swedish health care. Although UCCs have been established in other countries, their effectiveness and value have not yet been studied in Sweden. The aim of this study was to investigate the interaction between the UCC and emergency department (ED) by using validated evaluation models. One adult ED (AED) and one child ED (CED), together with a newly established UCC nearby, were included in this study. The interaction between the UCC team and the ED teams was studied by using two evaluation models: one for evaluation of integration and the other one for the evaluation of the effects, in terms of perceived relief of the ED after the establishment of the UCC. It was evident that integration was achieved early on in the course of the follow‐up. However, the perception of integration varied between low (EDs) and high collaboration (UCC). All respondents of the EDs indicated relief, in terms of pace and pressure on the ED since the UCC was established. This study indicates that the grade of integration and collaboration between UCC and ED can be achieved automatically and very early during the establishment. It also shows that UCCs can be a competent complement to EDs and alleviate some of the heavy pressure placed on EDs due to ED overcrowding.

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“…Such a reduction is of course dependent on local factors, i.e. the logistics in the local hospital where the study took place [ 17 , 19 , 20 ]. Therefore our results cannot be extrapolated to other hospitals either inside or outside Sweden.…”

Section: Discussionmentioning

confidence: 99%

A pathway care model allowing low-risk patients to gain direct admission to a hospital medical ward − a pilot study on ambulance nurses and Emergency Department physicians

Sundström

Petersson²,

Sjöholm³

et al. 2014

Scand J Trauma Resusc Emerg Med

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A pathway care model allowing low-risk patients to gain rapid admission to a hospital medical ward − a pilot study on ambulance nurses and Emergency Department physicians.BackgroundPatients with non-urgent medical symptoms who nonetheless require inpatient hospital treatment often have to wait for an unacceptably long time at the Emergency Department (ED). The purpose of this study is to evaluate the feasibility and effect on length of delay of a pathway care model for low-risk patients who have undergone prehospital assessment by an ambulance nurse and ED assessment by a physician within 10 minutes of arrival at the ED.MethodsThe pilot study comparing two low-risk groups took place in western Sweden from October 2011 until January 2012. The pathway model for low-risk patients was used prospectively in the rapid admission group (N = 51), who were admitted rapidly after being assessed by the nurse on scene and then assessed by the ED physician on ED admission. A retrospectively assembled control group (N = 51) received traditional care at the ED. All p-values are age-adjusted.ResultsPatients in the rapid admission group were older (mean age 80 years old) than patients in the control group (mean age 73 years old) (p = 0.02). The median delay from arrival at the patient’s side until arrival in a hospital medical ward was 57 minutes for the rapid admission group versus 4 hours 13 minutes for the control group (p < 0.0001). However, the median delay time from the ambulance’s arrival at the patient’s side until the nurse was free for a new assignment was 77 minutes for the rapid admission group versus 49 minutes for the control group (p < 0.0001). The 30-day mortality rate was 20% for the rapid admission group and only 4% for the control group (p = 0.16).ConclusionThe pathway care model for low-risk patients gaining rapid admission to a hospital medical ward shortened length of delay from the first assessment until arrival at the ward. However, the result was achieved at the cost of an increased workload for the ambulance nurse. Furthermore patients who were rapidly admitted to a hospital ward had a high age level and a high early mortality rate. Patient safety in this new model of fast-track assessment needs to be further evaluated.

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The clinical consequences of a pre-hospital diagnosis of stroke by the emergency medical service system. A pilot study

Cited by 17 publications

References 15 publications

Prehospital assessment of suspected stroke and TIA: An observational study

Prehospital assessment of suspected stroke and TIA: An observational study

Urgent care centre in Sweden—the integration of teams and perceived effects

A pathway care model allowing low-risk patients to gain direct admission to a hospital medical ward − a pilot study on ambulance nurses and Emergency Department physicians

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