Abstract 171: Stroke Identification by Emergency Medical Services: Determinants and its Impact on In-Patient Care

Abstract

Background: Recognizing acute stroke by Emergency Medical Services (EMS) is critical for timely care. We assessed the accuracy and determinants of stroke diagnosis by EMS and evaluated its impact on stroke patient care in Georgia. Methods: Data from the Georgia Coverdell Acute Stroke Registry on 6,586 clinically diagnosed and hospitalized acute stroke patients were linked to the 2016 Georgia EMS Information System. Accuracy of EMS recognition of clinically diagnosed stroke (sensitivity) was estimated using hospital diagnosis as the gold standard. Multivariable logistic regression was applied to identify determinants of stroke diagnosis and assess its impact on stroke patient care using door-to-imaging time. Results: EMS sensitivity of identifying acute stroke was 48.6%. In a multivariable model, considering ischemic stroke patients only, correct EMS diagnosis was positively associated with emergency medical dispatch (EMD) report of stroke (OR=4.67; 95%CI: 3.96-5.50); severity of stroke as measured by NIH stroke scale score (OR 5-14 Vs. 0-5 =2.17, 95%CI: 1.83-2.57; OR 15+ Vs. 0-5 =4.23, 95%CI: 3.37-5.32); clinical signs of slurred speech (OR=2.35, 95%CI: 2.00-2.75); and weakness of the extremities (OR=1.57, 95%CI: 1.33-1.85). Correct diagnosis was negatively associated with altered level of consciousness (OR=0.56, 95%CI: 0.46-0.70). Patients assisted by EMS with higher level of certification had higher odds (OR=1.36, 95%CI: 0.94-1.97) of being identified as having stroke than those attended by emergency medical technicians with basic training. Patients identified as having stroke by EMS had 3.78 times higher odds (95%CI: 3.01-4.75) of receiving imaging within 25 minutes of hospital arrival than those who were missed by EMS. Conclusion: Pre-hospital identification of acute stroke improves in-hospital care; however, about half of stroke patients transported by EMS in 2016 were not identified in the field. Identification of acute stroke is associated with EMS personnel level of certification, EMD’s report of stroke, and presenting symptoms of the disease and its severity. Thus, it is essential to improve EMDs level of understanding of stroke, enhance EMTs skill in stroke identification for swifter cinical care and better patient outcomes.