Abstract
BackgroundPatients with acute ischemic stroke (AIS) who use emergency medical services (EMS) receive quicker reperfusion treatment which, in turn, mitigates post-stroke disability. However, nationally only 59% use EMS. We examined why AIS patients use or do not use EMS.MethodsDuring 2016–2018, a convenience sample of AIS patients admitted to a primary stroke center in South Carolina were surveyed during hospitalization if they were medically fit, available for survey when contacted, and consented to participate. The survey was programed into EpiInfo with skip patterns to minimize survey burden and self-administered on a touchscreen computer. Survey questions covered symptom characteristics, knowledge of stroke and EMS importance, subjective reactions, role of bystanders and financial factors. Descriptive and multiple regression analyses were performed.ResultsOf 108 inpatients surveyed (out of 1179 AIS admissions), 49% were male, 44% African American, mean age 63.5 years, 59% mild strokes, 75 (69%) arrived by EMS, 33% were unaware of any stroke symptom prior to stroke, and 75% were unaware of the importance of EMS use for good outcome. Significant factors that influenced EMS use decisions (identified by regression analysis adjusting for stroke severity) were: prior familiarity with stroke (self or family/friend with stroke) adjusted odds ratio, 5.0 (95% confidence interval, 1.6, 15.1), perceiving symptoms as relevant for self and indicating possible stroke, 26.3 (7.6, 91.1), and bystander discouragement to call 911, 0.1 (0.01,0.7). Further, all 27 patients who knew the importance of EMS had used EMS. All patients whose physician office advised actions other than calling EMS at symptom onset, did not use EMS.ConclusionSystematic stroke education of patients with stroke-relevant comorbidities and life-style risk factors, and public health educational programs may increase EMS use and mitigate post-stroke disability.
Highlights
Patients with acute ischemic stroke (AIS) who use emergency medical services (EMS) receive quicker reperfusion treatment which, in turn, mitigates post-stroke disability
49% were male, 44% African American, 59% had mild stroke, median admission National Institutes of Health Stroke Scale (NIHSS) score was 4.0, mean age 63.5 years, 33% unaware of any stroke symptom before the episode, and 75% were unaware of the importance of EMS use for better outcomes
EMS users differed from non-users as follows: all patients who knew the importance of EMS had used EMS
Summary
Patients with acute ischemic stroke (AIS) who use emergency medical services (EMS) receive quicker reperfusion treatment which, in turn, mitigates post-stroke disability. Emergency medical services (EMS) transport is associated with greater likelihood of hospital arrival within the intravenous alteplase treatment window, 4.5 h since stroke onset[5]. Among patients arriving within the alteplase window, neuroimaging and reperfusion treatment are initiated more rapidly for EMS arrivals[6, 7]. These effects are mediated by various events triggered by EMS. Patients’ knowledge about stroke symptoms and the decision to promptly call EMS at symptom onset may be critical for survival and mitigation of long-term disability for some patients
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