Abstract
Introduction: Stroke is a medical emergency requiring timely intervention to optimize patient outcomes. Intravenous (IV) thrombolytics, the only treatment currently FDA-approved for acute stroke, require pertinent medical history for treatment decisions. Key details are often missed in the prehospital setting and during hand-off communication between Emergency Medical Services (EMS) and hospital staff, which can delay the time to treatment. We evaluated if utilization of a ‘stroke alert sticker’ by EMS to capture standardized information in the field would decrease time to thrombolytic administration. Methods: A bright orange sticker, to be placed directly on the patient, was disseminated to our local EMS agency for use with all stroke-alert patients. It includes key elements that are important to timely treatment decision, including time last known well, contact information, symptoms, and relevant medications. We evaluated the impact of use of this sticker on acute ischemic stroke treatment metrics, including IV thrombolytic “door to needle” (DTN) time. Results: The study included 220 stroke-alert patients brought to our Comprehensive Stroke Center by EMS from May 2021 through February 2022. Mean NIHSS on arrival was 11 (± 9); mean age was 67 (± 16) years; and 52 % were female. 21 patients were treated with an IV thrombolytic. Overall, sticker utilization rate was 40% in the stroke-alert population, but utilization was 60% in patients administered an IV thrombolytic. With sticker utilization, DTN time was reduced by 20 minutes (31 ± 11 min with sticker vs 51 ± 20 min without, p=0.03). In patients who received IV thrombolytics, pre-hospital notification was 100% with sticker use compared to 75% without (p=0.01). Conclusion: Utilization of the stroke-alert sticker significantly improved DTN times for acute ischemic stroke patients compared to patients without the sticker. This evidence supports continued use of the stroke alert stickers to improve DTN times and improve patient outcomes. Further research is ongoing in a larger patient cohort.
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