Abstract W P216: Recognition Of Stroke By EMS Is Associated With Improved Emergency Department Quality Of Care

Abstract

Objective: Hospital arrival via Emergency Medical Services (EMS) has been associated with faster evaluation and treatment of stroke. Among stroke cases presenting via EMS, we sought to determine if accurate recognition of stroke by prehospital providers was associated with increased quality of care in the Emergency Department (ED). Methods: Single center retrospective study of patients presenting via EMS between September 2009 and October 2012 with a discharge diagnosis of transient ischemic attack (TIA), ischemic stroke (IS) or intracerebral hemorrhage (ICH). Hospital and EMS databases were used to determine dispatcher and EMS provider impression, pre-hospital and in-hospital time intervals, EMS prenotification, NIH stroke scale (NIHSS), symptom duration and use of tissue plasminogen activator (tPA). Multivariable models were constructed to determine independent associations. Results: There were 399 cases identified: 14.5% TIA, 67.2% IS, and 18.3% ICH. Dispatchers correctly identified 58.2% of cases and EMS providers correctly recognized 57.6% of cases. Compared to cases missed by EMS, strokes that were correctly recognized had longer median on-scene time (17 vs. 15 min, p=0.01) but shorter transport times (12 vs. 15 min, p=0.001). Cases correctly recognized by EMS had shorter door-to-physician time (4 vs. 11 min, p<0.001) and shorter door to CT time (23 vs. 48 min, p<0.001). These associations were independent of age, NIHSS, symptom duration, and EMS prenotification (Door to Physician β = -4.42, p=0.027; Door to CT β= -18.81, p<0.001). Among the 268 ischemic stroke patients, 155 (57.8%) were correctly recognized by EMS. Cases correctly recognized by EMS were more likely to receive tPA (15.7% vs. 3.6%, p<0.001). This remained significant after adjusting for age, NIHSS, symptom duration and EMS prenotification (OR=5.54, p=0.006). Conclusion: Recognition of stroke by EMS providers was independently associated with faster door to physician time, faster door to CT time, and greater odds of receiving tPA. Quality initiatives to increase EMS recognition of stroke have the potential to improve hospital based quality of care and outcomes after stroke.