Utilization of emergency medical service increases chance of thrombolytic therapy in patients with acute ischemic stroke

Hsieh, Ming‐Ju; Tang, Sung‐Chun; Chiang, Wen-Chu; Huang, Kuang Yu; Chang, Anna Marie; Ko, Patrick Chow In; Tsai, Li-Kai; Jeng, Jiann‐Shing; Ming, Matthew Huei

doi:10.1016/j.jfma.2013.10.020

Cited by 8 publications

(5 citation statements)

References 32 publications

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“…4 Utilization of emergency medical services (EMS) can increase the likelihood of appropriate therapy with recombinant tissue-type plasminogen activator. 5,6 Recently, several studies have been conducted to investigate EMS utilization and its influencing factors with acute stroke in developed countries. 7,8 However, information about EMS utilization among AIS patients in China is still unclear.…”

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confidence: 99%

Determinants of Emergency Medical Services Utilization Among Acute Ischemic Stroke Patients in Hubei Province in China

Yin

Yang

Gong

et al. 2016

Stroke

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Background and Purpose-Emergency medical services (EMS) can effectively shorten the prehospital delay for patients with acute ischemic stroke. This study aimed to investigate EMS utilization and its associated factors in patients with acute ischemic stroke in China. Methods-A cross-sectional study was conducted from October 1, 2014, to January 31, 2015, which included 2096 patients admitted for acute ischemic stroke from 66 hospitals in Hubei province in China. A multivariable stepwise logistic regression model was undertaken to identify the factors associated with EMS utilization. Results-Of the 2096 participants, only 323 cases (15.4%) used EMS. Those acute ischemic stroke patients who previously used EMS (odds ratio [OR] =9.8), whose National Institutes of Health Stroke Scale score was ≥10 (OR=3.7), who lived in urban communities (OR=2.5), who had sudden onset of symptoms (OR=2.4), who experienced their first stroke (OR=1.8), and who recognized initial symptom as stroke (OR=1.4) were more likely to use EMS. Additionally, when acute ischemic stroke patients' stroke symptom were noticed first by others (OR=2.1), rather than by the patients, EMS was more likely to be used. Conclusions-A very low proportion of patients with acute ischemic stroke used the EMS in Hubei province in China.Considerable education programs are required regarding knowledge of potential symptoms and the importance of EMS for stroke.

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confidence: 99%

Determinants of Emergency Medical Services Utilization Among Acute Ischemic Stroke Patients in Hubei Province in China

Yin

Yang

Gong

et al. 2016

Stroke

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“…In line with other studies, an association between stroke occurring outside the home and early arrival at the hospital was observed (OR 3.03; 95% CI 1.22–7.55; OR 7.09; 95% CI 1.95–25.55). When the stroke occurs in public places, symptom onset is more likely witnessed by family members, friends, or bystanders who often take a more active approach and request medical assistance quickly [33]. Patients having a stroke during the daytime (06:00–22:00) were admitted earlier than those having one during the nighttime (22:00–06:00) (OR 7.73; 95% CI 3.09–19.34) because it is difficult to recognize at night at home and patients often wait to recover spontaneously [26,27,34,35].…”

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confidence: 99%

Factors Associated with Shortening of Prehospital Delay among Patients with Acute Ischemic Stroke

Soto-Cámara

González‐Santos

González-Bernal

et al. 2019

JCM

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Background: Despite recent advances in acute stroke care, only 1–8% of patients can receive reperfusion therapies, mainly because of prehospital delay (PHD). Objective: This study aimed to identify factors associated with PHD from the onset of acute stroke symptoms until arrival at the hospital. Methods: A cross-sectional study was conducted including all patients consecutively admitted with stroke symptoms to Burgos University Hospital (Burgos, Spain). Socio-demographic, clinical, behavioral, cognitive, and contextualized characteristics were recorded, and their possible associations with PHD were studied using univariate and multivariable regression analyses. Results: The median PHD of 322 patients was 138.50 min. The following factors decreased the PHD and time until reperfusion treatment where applicable: asking for help immediately after the onset of symptoms (OR 10.36; 95% confidence interval (CI) 4.47–23.99), onset of stroke during the daytime (OR 7.73; 95% CI 3.09–19.34) and the weekend (OR 2.64; 95% CI 1.19–5.85), occurrence of stroke outside the home (OR 7.09; 95% CI 1.97–25.55), using a prenotification system (OR 6.46; 95% CI 1.71–8.39), patient’s perception of being unable to control symptoms without assistance (OR 5.14; 95% CI 2.60–10.16), previous knowledge of stroke as a medical emergency (OR 3.20; 95% CI 1.38–7.40), call to emergency medical services as the first medical contact (OR 2.77; 95% CI 1.32–5.88), speech/language difficulties experienced by the patient (OR 2.21; 95% CI 1.16–4.36), and the identification of stroke symptoms by the patient (OR 1.98; 95% CI 1.03–3.82). Conclusions: The interval between the onset of symptoms and arrival at the hospital depends on certain contextual, cognitive, and behavioral factors, all of which should be considered when planning future public awareness campaigns.

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“…Prehospital notification of a stroke event by EMS staff is associated with improved rates of recombinant tissue plasminogen activator (rt-PA) delivery and reduced door-to-needle times [1][2][3][4]. Therefore, prehospital stroke recognition via stroke scoring is an efficient means of minimizing time to treatment in patients.…”

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confidence: 99%

Ten-Year Evaluation of the TOYOTA Prehospital Stroke Scale for Tissue Plasminogen Activator Intravenous Therapy in the Real World

et al. 2018

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Background: Emergency medical services are an important part of acute stroke management. We devised a prehospital stroke scale, the TOYOTA prehospital stroke scale for tissue plasminogen activator (t-PA) intravenous therapy (TOPSPIN) for triaging patients with ischemic stroke and especial indications for intravenous t-PA therapy in December 2006; this scale comprises 5 items including consciousness, atrial fibrillation, language disorder, disturbance of the upper extremities, and disturbance of the lower extremities. The aim of this study was to analyze the results of 10 years of TOPSPIN implementation and to distinguish ischemic stroke from hemorrhagic stroke in the real world. Methods: We prospectively enrolled consecutive patients who were transferred to our hospital and evaluated by Toyota city ambulance services using the TOPSPIN from December 2006 to January 2017. We examined definite diagnosis at the time of hospital discharge (ischemic stroke, hemorrhagic stroke, or stroke mimic), positive-predictive value of the stroke, the rate of the recanalization therapy, and clinical differentiation among patients with hemorrhagic stroke, ischemic stroke, and stroke mimics. Results: A total of 1,482 consecutive patients were enrolled; 1,134 (76.5%) were patients with stroke (628 ischemic-type, 34 transient ischemic attack-type, and 472 hemorrhagic-type) and 348 (23.5%) without stroke (80 with seizure, 42 with syncope, 27 with hypoglycemia, and 199 other). Among 628 patients with ischemic stroke, 130 (20.7%) received intravenous recombinant t-PA treatment, endovascular therapy, or both. The presence of atrial fibrillation, older age, lower blood pressure, and lower total TOPSPIN score was more commonly associated with ischemic stroke than with hemorrhagic stroke. In multivariable logistic regression analysis, the presence of atrial fibrillation was independently associated with ischemic stroke (OR 2.33; 95% CI 1.61–3.40). Conclusions: The TOPSPIN is a simple prehospital stroke scale that includes an assessment of atrial fibrillation. Detection of atrial fibrillation in the prehospital stage may point to a higher probability of ischemic stroke.

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Utilization of emergency medical service increases chance of thrombolytic therapy in patients with acute ischemic stroke

Cited by 8 publications

References 32 publications

Determinants of Emergency Medical Services Utilization Among Acute Ischemic Stroke Patients in Hubei Province in China

Determinants of Emergency Medical Services Utilization Among Acute Ischemic Stroke Patients in Hubei Province in China

Factors Associated with Shortening of Prehospital Delay among Patients with Acute Ischemic Stroke

Ten-Year Evaluation of the TOYOTA Prehospital Stroke Scale for Tissue Plasminogen Activator Intravenous Therapy in the Real World

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