Abstract
Background: rtPA for AIS is time sensitive, requiring efficient and coordinated acute care. We evaluated time to evaluation, stroke diagnosis, treatment rate, and 90 day outcome in patients with stroke team prenotification by EMS and those identified after arrival. Methods: The UCSD SPOTRIAS prospectively collected database was analyzed for patients with stroke team prenotification by EMS and other patients seen in stroke code, excluding inpatient codes. Multivariable regression models used outcome of interest as independent variable. Models were adjusted for pre-specified covariates: pre-stroke mRS, age, gender, smoking, baseline NIHSS and glucose. Time differences between groups were analyzed using Wilcoxon Rank Sum Tests. Results: We assessed 2867 patients, with EMS prenotification in 643 (22.4%). Assessment at 90 days was obtained in 216 with prenotification and 807 others. Those with prenotification were older (mean 68 vs 66, p=0.0498), with higher pre-stroke mRS (p=0.0243), NIHSS (10.9 vs 8.5, p< 0.0001) and glucose (139 vs 135, p=0.0013). Prenotification led to shorter time to imaging, decision, and IV rtPA treatment (all p<0.0001). No difference was seen in IV rtPA treatment rate (18% EMS prenotifications vs 16% others). When controlling for baseline characteristics, stroke was diagnosed more frequently in patients without EMS prenotification (OR 1.31, 95% CI 1.08-1.58, p=0.0057). Poor outcome (mRS 3-6) was seen more frequently in prenotification patients (45.83% vs 35.32%, p=0.006, NS after adjusting for baseline covariates). Conclusions: In the UCSD experience, EMS prenotification leads to faster evaluation critical in stroke. Prenotification occurred in patients at a medically worse baseline, but did not result in higher rates of final stroke diagnosis or IV rtPA. With improved education, accurate identification of AIS patients may improve, further expediting care and improving treatment and outcomes.
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