Access to Thrombolysis for Non-Resident and Resident Stroke Patients-A Registry-Based Comparative Study from Berlin.

Ludwig Schlemm,Guillaume Turc,Martin Ebinger,Heinrich J Audebert

doi:10.3389/fneur.2017.00319

Abstract

Stroke can happen to people away from home. It is unknown whether non-resident and resident stroke patients have equal access to thrombolysis. Consecutive patients cared for by the Stroke Emergency Mobile between 2011 and 2016 after prompting suspicion of acute stroke during the emergency call were included in our registry. Patients were categorized as residents or non-residents based on their main address. Clinical characteristics, thrombolysis rates, and time intervals from symptom onset/last seen well to alarm and to thrombolysis were compared between groups adjusting for age, pre-stroke modified Rankin Scale (mRS) score, and National Institutes of Health Stroke Scale (NIHSS) score. Of 4,254 patients for whom a stroke dispatch was activated, 2,451 had ischemic or hemorrhagic strokes, including 73 non-residents. Non-resident stroke patients were younger (median 69.4 vs. 76.6 years, p < 0.001), had less pre-stroke disability (mRS ≥ 2:17.8 vs. 47.5%, p < 0.001) and less severe strokes (median NIHSS 4 vs. 5, p = 0.02). Thrombolysis rates were higher in non-residents (30.9 vs. 22.0% of ischemic stroke patients, p = 0.04) and emergency calls were made faster (symptom onset/last-seen-well-to-alarm time 35 vs. 144 min, p = 0.04). A lower proportion of non-residents had unknown time of symptom onset (21.9 vs. 46.4%, p < 0.001). For patients with known time of symptom onset, thrombolysis rates, and prehospital delays were similar among non-residents and residents. In this study, non-resident stroke patients had higher rates of thrombolysis than residents. This may be explained by a lower proportion of patients with unknown time of symptom onset.

Highlights

Mobility and traveling at the international level has been increasing constantly at a rate of approximately 3.9% annually [1]
Stroke and transient ischemic attack are common among tourist patients presenting to emergency departments [8] and correspond to the most frequent medical conditions leading to repatriation [9]
Consecutive adult patients managed by a specialized prehospital stroke ambulance equipped with a computerized tomography (CT) scanner and staffed with a stroke neurologist [the Stroke Emergency Mobile (STEMO)] between February 2011 and November 2016 were entered into a prospective registry, as described previously [12,13,14]

Summary

Introduction

Mobility and traveling at the international level has been increasing constantly at a rate of approximately 3.9% annually [1]. Access to Thrombolysis for Non-Residents in Berlin population is getting older [6], the number of elderly tourists is likely to increase in the future. People in this age group tend to have more premorbid conditions [7] and may be more likely to need medical attention while away from their homes. Immediate medical care and treatment are of crucial importance for patients with suspected stroke and lead to improved outcome [10, 11] It remains uncertain whether staying in a foreign city affects the decision-making of individuals with stroke symptoms or witnesses to call emergency services and patients’ access to timely treatment. We aimed to compare clinical characteristics, rates of intravenous thrombolysis, and prehospital delays between non-residents and residents stroke patients in a large prehospital registry

Objectives

Methods

Results

Conclusion