Abstract TP102: Pre-Hospital Obtention of Vital Information for Decision Enforcement in Cerebrovascular Emergencies: The PROVIDENCE Study

Abstract

Background: Difficulties determining an acute ischemic stroke patient's eligibility for intravenous thrombolysis (IVT) treatment is a frequent cause of delays. Objective: To assess the effectiveness of the "PROVIDENCE" datasheet, a pre-assessment of contraindications for IVT use applied by emergency medical services personnel in the field. Methods: This is a quasi-experimental study to evaluate the efficacy of the PROVIDENCE datasheet used by first responders. Participants were eligible if they were over 18 years old and presented to our center from the field with stroke-like symptoms with onset within 4.5 h. Results: We identified 465 records and included 166 records in our final analysis (54 in the study group and 112 in the control group). Eighty-five of the 166 patients received IVT (30 in the study group patients and 55 in the control group). The PROVIDENCE datasheet showed a noticeable median improvement in corrected time by five minutes from the patient's initial presentation at the emergency department to the final decision regarding IVT eligibility (p = 0.032). Additionally, the time between the first encounter with a neurology provider and the decision regarding IVT administration saw a median improvement of six minutes (p = 0.002) for the entire sample. In the subgroup that received IVT, the PROVIDENCE datasheet decreased by seven minutes (p = 0.044) the median time between the first encounter by the neurology provider and the decision regarding the administration of IVT. All other comparisons were not significant. However, the PROVIDENCE datasheet decreased the door-to-needle time by 6.5 minutes compared to the control group. Conclusion: Using the PROVIDENCE datasheet, first responders can quickly identify potential contraindications for IVT treatment in patients with stroke-like symptoms. This tool expedited decision-making and led to faster IVT administration process at a comprehensive stroke center.