Abstract
BackgroundIn acute ischemic stroke, conjugated eye deviation (CED) is an evident sign of cortical ischemia and large vessel occlusion (LVO). We aimed to determine if an emergency dispatcher can recognise LVO stroke during an emergency call by asking the caller a binary question regarding whether the patient’s head or gaze is away from the side of the hemiparesis or not. Further, we investigated if the paramedics can confirm this sign at the scene. In the group of positive CED answers to the emergency dispatcher, we investigated what diagnoses these patients received at the emergency department (ED). Among all patients brought to ED and subsequently treated with mechanical thrombectomy (MT) we tracked the proportion of patients with a positive CED answer during the emergency call.MethodsWe collected data on all stroke dispatches in the city of Tampere, Finland, from 13 February 2019 to 31 October 2020. We then reviewed all patient records from cases where the dispatcher had marked ‘yes’ to the question regarding patient CED in the computer-aided emergency response system. We also viewed all emergency department admissions to see how many patients in total were treated with MT during the period studied.ResultsOut of 1913 dispatches, we found 81 cases (4%) in which the caller had verified CED during the emergency call. Twenty-four of these patients were diagnosed with acute ischemic stroke. Paramedics confirmed CED in only 9 (11%) of these 81 patients. Two patients with positive CED answers during the emergency call and 19 other patients brought to the emergency department were treated with MT.ConclusionA small minority of stroke dispatches include a positive answer to the CED question but paramedics rarely confirm the emergency medical dispatcher’s suspicion of CED as a sign of LVO. Few patients in need of MT can be found this way. Stroke dispatch protocol with a CED question needs intensive implementation.
Highlights
In acute ischemic stroke, conjugated eye deviation (CED) is an evident sign of cortical ischemia and large vessel occlusion (LVO)
The answer to the CED question was available for 1900 dispatches: answers were ‘no’, ‘yes’, and ‘unknown’ in 688 (36%), 81 (4%) and 810 (43%) dispatches, respectively, while in 321 (17%) dispatches, the question was unanswered
Of the 81 cases with positive answers to the CED question gained during dispatch, 24 cases (30%) were diagnosed in the emergency department (ED) as acute ischemic stroke (AIS), four cases (5%) were diagnosed as spontaneous intracerebral haemorrhage, 10 cases were not transported by ambulance to the ED, and stroke was not identified in the remaining 43 cases (53%)
Summary
In acute ischemic stroke, conjugated eye deviation (CED) is an evident sign of cortical ischemia and large vessel occlusion (LVO). Extensive measures have been implemented to reduce the in-hospital delays of door-to-treatment-time to recanalise the occluded artery by means of pharmacological thrombolysis or endovascular mechanical thrombectomy (MT) of LVO [6, 7]. Despite such efforts, prehospital delays reduce the likelihood of achieving the best post-AIS outcome. Continual stroke awareness campaigns directed at the public are needed to decrease onset-to-call times [8] It takes only a median of 3 min after receiving the emergency call to dispatch the emergency medical services (EMS) [9], but dispatching the EMS with a correct suspicion of stroke increases the probability of the paramedics recognising an actual stroke case [10]. When the paramedics suspect stroke, they are more likely to give the appropriate prenotification to the receiving hospital, which in turn decreases the in-hospital delay [11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
