Abstract WP89: National Assessment of Key Prehospital Stroke Care Practices and Their Association to Patient Characteristics

Abstract

Background: Emergency medical service (EMS) clinicians provide time-sensitive care for patients with suspected stroke. While model evidence-based guidelines (EBG) exist, there is limited research on national adoption. Our objectives were to describe nationwide care delivery for suspected stroke patients and measure associations between guideline-compliant stroke care (GCSC) and patient characteristics. Methods: This retrospective analysis of the 2022 national ImageTrend Collaborate dataset evaluated 9-1-1 transported EMS incidents with primary impression of stroke. Included are advanced life support agencies with >6 annual strokes. Key components of GCSC from the National Model EMS Clinical Guidelines include documented stroke screen, 12-lead electrocardiogram, blood glucose (BG), onset time/last known well (LKW/Onset), pre-alert hospital notification, and scene time <15 minutes. Provision of GCSC was defined as providing at least five of the six components above. Multivariable logistic regression(OR,95%CI) used to describe the odds of GCSC adjusted for race/ethnicity, gender, and urbanicity. Results: In 2022, 43,555 events met inclusion criteria. Patients were commonly White (70.5%), female (52.3%), and with a median age 73 (IQR:62, 82). Most were in urban areas (88.2%) and had a dispatch complaint of stroke (56.1%). Key components of GCSC had varying degrees of compliance: stroke assessment (83.9%), LKW/Onset (93.7%), BG (85.1%), 12-lead (42.3%), pre-alert (58.7%) and on-scene time <15 minutes (58.9%). At least five components were completed in 43.0% of patients, and only 10.0% had all six. Adjusted odds of GCSC were higher for males (1.12,1.08-1.17), lower for Black/African American patients (0.71,0.67-0.76; referent: White), and lower for suburban and rural areas (0.52,0.48-0.56; 0.39,0.32-0.47; referent: urban). Conclusion: Prehospital GCSC delivery in the United States varies widely even with EBG’s providing a standardized approach. Variations in care are associated with gender, race, and urbanicity. Our results may be limited by reporting bias in the medical record. Future efforts may focus on agency-level implementation and documentation of these criteria to improve patient-based outcomes.