Abstract W P214: Identifying Stroke Symptoms in the Field: What are we Missing?

Abstract

Introduction: Emergency Departments (ED) are increasingly activating stroke codes based on assessment of stroke symptoms via Emergency Medical Services (EMS). Accurate assessment of stroke symptoms by EMS facilitates rapid assessment in the ED, leading to prompt diagnosis and treatment during an acute stroke. Delays in treatment can occur when stroke symptoms are not recognized in the field. Hypothesis: We hypothesized that trends existed in stroke symptoms most commonly missed by EMS. Methods: A retrospective cohort study of 170 records was reviewed, for all patients receiving acute stroke care at an urban hospital from October 2013 to May 2014. Inclusion criteria: stroke code activation by EMS or in the ED, and patient arrival by EMS. Exclusion criteria: stroke code activations after admission to the hospital, and patients arriving via private transportation. Results: 112 patients met the inclusion and exclusion criteria. 90 patients (80%) had stroke codes were initiated by EMS. The remaining 22 patients had stroke codes initiated by the ED MD after arrival. The records of the 22 patients arriving to the ED without advanced EMS notification were reviewed. Aphasia was documented in the EMS record for 8 patients (36%). An additional 8 patients (36%) with documented stroke symptoms arrived without EMS notification due to improving symptoms or unclear last known well time. Five of the 22 patients (23%) arriving without EMS pre-notification had had aaphasia documented as an initial finding by ED MD, had a stroke code activation and received IV tPA. One of the 5 patients (13%) also had improving symptoms documented by EMS. Conclusion: An opportunity exists for improved recognition of aphasia as a stroke symptom by EMS, including both expressive and receptive components. Likewise, further education is needed correlating aphasia with the likelihood of IV tPA initiation in the ED. This study also highlights the importance of recognizing the waxing and waning nature of stroke symptoms. Rapidly improving symptoms should not preclude stroke code initiation via EMS, as some of these patients are still IV tPA candidates.