Abstract TP283: Ambulance Service Use and Associations With Hospital Care and 90-day Outcomes for Acute Stroke: The Australian Stroke Clinical Registry (AuSCR)

Abstract

Introduction: Hospital arrival via ambulance may influence treatment options and outcomes of acute stroke. A national study for Australia has not previously been reported, and inclusion of long-term outcomes is rare. We aimed to determine differences in the characteristics of patients and their outcomes by route of hospital presentation. Methods: Patient-level data linkage of Australian Stroke Clinical Registry (AuSCR) patients with first-ever strokes between January 2010 and December 2013 (n=40 hospitals) were merged with emergency and hospital admissions, and death records. Multilevel regression models were used to determine associations with hospital care and outcome by type of transport to hospital. Results: Among 9315 patients with first-ever stroke, 5601 (60%) arrived by ambulance (52% male; 79% ischemic). Compared to patients arriving by private transport, those arriving by ambulance were older (ambulance, median 77 vs. private, 72 years; P<0.001), more often had an intracerebral hemorrhage (ICH, ambulance 18% vs 15%; P<0.001), and were unable to walk (proxy for stroke severity: ambulance 73% vs. 50%; P<0.001). Median times to hospital were shorter via ambulance (135 vs. 229 mins; P<0.001), and patients arriving by private transport were less likely to receive acute therapies (rtPA for ischemic stroke, ambulance 16% vs 8%; aspirin <48 hrs, ambulance 75% vs 63%) or swallow screen/assessment (ambulance 89% vs 75%). After accounting for patient/hospital characteristics, compared with patients arriving by private transport, those using ambulances more often received inpatient rehabilitation (aOR 1.57, 95%CI 1.30-1.64), but more often died within 30-days (aOR 1.23) or reported worse quality-of-life at 90-180 days (coefficient: -4.4, 95%CI -7.4 to -1.4). Conclusion: Patients with first-ever stroke who take private transport to hospital experience treatment disadvantages but not worse outcomes. Public education on calling an ambulance for stroke symptoms remains important.