Abstract WMP65: The Quality of Pre-hospital Acute Stroke Care: Data from a Pilot Surveillance System

Abstract

Background: Evaluation of prehospital stroke care quality has been limited by the inability to link EMS and hospital data. The Prehospital Acute Stroke Surveillance System (PASSS) is designed to assess prehospital stroke care in Kent Country, Michigan through linkage of EMS and hospital data for patients transported with suspected or confirmed stroke. Methodology: EMS transported patients were eligible for inclusion if stroke was suspected by EMS dispatchers or providers prehospital or confirmed after hospital admission. Electronic records containing data elements derived from the National EMS Information System (NEMSIS) were obtained from all three EMS agencies in the county and manually linked to in-hospital data from 2 stroke center hospitals. Outcome measures included the accuracy of prehospital stroke recognition by EMS dispatchers and providers and the proportion of runs with documentation of symptom onset time, scene time ≤ 10 minutes, pre-hospital stroke screen, blood glucose, and hospital pre-notification. Results: In the first three months, 167 EMS transported patients were entered into PASSS; 58 (35%) were confirmed as stroke cases after admission. Emergency dispatchers missed 36% (n=21) of confirmed strokes and EMS providers missed 22% (n=13). The false positive rate for stroke identification was 69% (82/119) among dispatchers and 54% (53/98) among EMS providers. Among 98 cases identified by EMS as suspected stroke, documentation rates were 82% for symptom onset time, 86% for prehospital stroke screen, 87% for blood glucose, 10% for scene time ≤10 minutes, and 61% for hospital prenotification. Among 26 patients with a positive prehospital stroke screen and onset of symptoms < 120 minutes, the prenotification rate increased to 77%. Two patients received IV tPA. Conclusions: The PASSS illustrates that substantial opportunities for improvement in EMS prehospital stroke care exist, including stroke recognition and compliance with quality measures. The high rate of false-positive prehospital stroke identification has important implications for the development of regional stroke systems.