Abstract TP71: Characteristics And Demographics Of Patients Using Emergency Medical Services For Suspected Acute Stroke And Its Impact On Long-term Outcomes In A Multi Ethnic Population

Abstract

Introduction: Acute ischemic stroke (IS) patients who receive IV thrombolysis are more likely to have good long-term prognosis. Unfortunately, more than two-third of IS patients present outside the therapeutic window. The use of emergency medical services (EMS) can reduce pre-hospital delay and increase likelihood of treatment with t-PA. We aim to determine the characteristic variations amongst the suspected acute stroke patients using EMS. Methods: In this retrospective observational study, all suspected acute stroke patients admitted to Hamad General Hospital from April 30, 2014 to September 15, 2020 were included. We evaluated demographics, clinical features, impact on treatment and associated factors in EMS versus non-EMS group. Results: During the study period, 11892 patients presented as suspected acute stroke. Of these, 65.1% used EMS (EMS-group). Mean age in EMS group was 53.4 + 14.1 versus 52.6 + 14.0 in non-EMS group (p = 0.003). Male to female ratio in both groups was 3:1. The proportion of patients who used EMS were higher in the Asian (66.8%), African (66.8%) and Caucasian (66.6%) population as compared to Arabs (61.9%). EMS use in Qatari population (59.2%) was relatively low. Intracerebral hemorrhage patients (82.4%) had a significantly higher EMS use followed by IS (65.7%) and cerebral venous thrombosis (64.7%); p<0.001. Symptom onset time of less than 4.5 hours at presentation was reported by 41% in EMS-group versus 24.3% in Non-EMS group. Patients with prior stroke (65.5%) and transient ischemic attack (58.4%) preferred EMS as compared to Non-EMS group (34.5% and 41.5%). Patients with unilateral weakness (66.4%) aphasia (78.2%), neglect (78.2%), dysarthria (68.4%), loss of consciousness (83.3%) and seizures (83.9%) had a higher use of EMS versus non-EMS group. The thrombolysis rate in EMS group was high vs non-EMS (82.4% vs 17.6%; p<0.001) with a door-to-needle time significantly lower in the EMS group (56.4 + 38.2 vs 75.7 + 43.8; p<0.001). Conclusion: EMS use facilitate rapid transfer, timely stroke evaluation and management of patients who need time-critical care. Patient characteristics and demographics, clinical symptoms and stroke type are associated with early stroke recognition and EMS use leading to higher recanalization rate.