Abstract 13202: The Accuracy Of EMS Dispatch For Stroke Following The Introduction Of The Stroke Diagnostic Tool

Abstract

Introduction: Early identification of stroke in the emergency call is key to timely reperfusion therapy. The Medical Priority Dispatch System (MPDS) is widely used and recent versions include a Stroke Diagnostic Tool (SDxT) using the FAST (Face, Arm, Speech) assessments. We conducted a retrospective observational study to examine whether introduction of the SDxT improved the identification of stroke/TIA in the emergency call in Victoria, Australia. Methods: We included all stroke dispatches (MPDS Code 28) for adults (aged ≥20 years) between 2008 and 2015. We linked this data to diagnoses from Ambulance Victoria, and the Victorian Department of Health and Human Services’ databases: the Victorian Emergency Minimum Dataset and the Victorian Admitted Episode Database. We examined the use of SDxT codes, and compared the proportion of stroke/TIA diagnoses before and after the introduction of the SDxT in September 2013. Results: Over the study period there were 108,917 Code 28 cases (average 13,600/year), 80% (n=86,906) were transported to an ED and 55% (n=60,334) were admitted to hospital. There were 3,141 diagnoses among the Code 28 cases, with 30% diagnosed with stroke/TIA. No changes was seen in the proportion of stroke/TIAs after the introduction of the SDxT (28.5% vs. 28.2%, p=0.23). The SDxT was used and complete in 63% (n=20,070) of calls. Patients with evidence of stroke on the SDxT were more likely to have stroke/TIA (partial evidence=29%, strong evidence=38% and clear evidence=40%) compared to those with no evidence (20%) and those with no/incomplete SDT (25%). Conclusions: Our results suggest a large proportion of stroke dispatches are not stroke/TIA, but evidence of stroke on the SDxT does identify marginally higher proportions. Further research is required to understand use of the tool, and public education on stroke assessments may be needed to realise its full potential.