Abstract WP470: Stroke’s Pathways of Patients Transported by Advanced Life Support Ambulance: A 26 Years Registry

Abstract

Introduction: Since mid-2000, stroke guidelines were revised and 18 stroke units (SU) settled in Paris area (France). Our Emergency Medical Service (EMS) in a catchment of 500 000 inhabitants registered all acute strokes where dispatch of an Advanced Life Support (ALS) ambulance was decided since 1993. Methods: Data were collected from an EMS registry (1993-2019). The study included patients 16 years old and over, with an acute stroke requiring an ALS ambulance. Collected data were gender, age (by quartile), time periods (1993-99, 2000-04, 2005-09, 2010-14, 2015-19) and receiving care facility: SU, neurosurgery, intensive care unit (ICU), emergency department (ED), radiology department (MRI or scanner) or left on scene (LOS dead or alive). Comparisons were performed with Chi-2 test. Results: This study included 2955 stroke patients, mean age was 70.7 years old, sex ratio was 0.93. Table 1 and graphic 1 results show the emergence of SU during mid-2000, with a decrease of ED transfers, while neurosurgery and ICU remained steady (p<10 -3 ). This decrease of ED was more important for older age groups (≥ 75 years old). Conclusion: Older age groups benefitted more from specialized pathways including ICU and SU, with less transports to ED, but never clearly from neurosurgery. Development of SU probably explains the decreased number of younger patients in neurosurgery. Literature shows that direct pathway to SU significantly improved prognosis of stroke patients. This registry of ALS transports shows its growing use in EMS dispatch, as for ST+ myocardial infarction, while transports to ED decrease. It would be interesting to compare these results with those of faster Basic Life Support transports.