Abstract TP246: Emergency Medical Service Transportation Is Associated With Improved Evaluation and Treatment of Acute Ischemic Stroke

Abstract

Background: Emergency medical services (EMS) transportation of a potential stroke patient may provide a means of reducing evaluation and treatment times and improve fibrinolytic treatment rates; yet, state-level data have not been linked to diagnosis at discharge and clinical outcomes. Objectives: To link the South Carolina (SC) statewide EMS database with hospital discharge diagnosis and evaluate the impact of EMS transportation in improving identification and treatment of acute stroke. Methods: A retrospective analysis was conducted of the statewide EMS database linked with statewide hospital discharge records stored at SC Department of Health and Environmental Control, for the calendar year 2010. Patients with a discharge diagnosis of stroke were included in the analysis. Patients transported via EMS were compared with patients not transported by EMS. Variables considered included patient demographics, transportation time, location/ type of destination hospital and treatment with intravenous tissue plasminogen activator (tPA). Results: In the year 2010, 18,962 hospitalized patients in SC were assigned a primary discharge diagnosis of stroke. Of these, 36% (6,824) were transported via EMS. The average time from 911 call to hospital arrival was 44.6 minutes. Time from 911 calls to EMS on scene was on average of 1.2 minutes longer for patients residing in rural areas than those in urban areas. About 48% of all stroke cases were treated in primary stroke centers (PSCs) and 4.3% of all ischemic cases received thrombolytic therapy. EMS identification of stroke signs and symptoms was associated with shorter transfer times and a higher transfer rate to a PSC than cases whose symptoms were not identified as stroke by EMS (50% vs. 43% for all strokes, P<0.001; 50% vs. 41% for ischemic strokes, P<0.001). For patients with ischemic stroke, EMS identification of stroke resulted in a markedly higher tPA treatment rate (10.9%) than cases whose symptoms were not identified as stroke by EMS (3.6%) and cases arriving by private vehicles (3.5%, P<0.001). Conclusions: EMS identification of stroke signs and symptoms was associated with increased rate of transportation to PSCs and fibrinolytic treatment for ischemic stroke.