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. 2012 Aug;1(4):e002345.
doi: 10.1161/JAHA.112.002345. Epub 2012 Aug 24.

Patterns, predictors, variations, and temporal trends in emergency medical service hospital prenotification for acute ischemic stroke

Cheryl B Lin  1 , Eric D Peterson, Eric E Smith, Jeffrey L Saver, Li Liang, Ying Xian, Daiwai M Olson, Bimal R Shah, Adrian F Hernandez, Lee H Schwamm, Gregg C Fonarow
Affiliations

Patterns, predictors, variations, and temporal trends in emergency medical service hospital prenotification for acute ischemic stroke

Cheryl B Lin et al. J Am Heart Assoc. 2012 Aug.

Abstract

BACKGROUND#ENTITYSTARTX02014;: Emergency medical services (EMS) hospital prenotification of an incoming stroke patient is guideline recommended as a means of increasing the timeliness with which stroke patients are evaluated and treated. Still, data are limited with regard to national use of, variations in, and temporal trends in EMS prenotification and associated predictors of its use. METHODS AND RESULTS#ENTITYSTARTX02014;: We examined 371 988 patients with acute ischemic stroke who were transported by EMS and enrolled in 1585 hospitals participating in Get With The Guidelines-Stroke from April 1, 2003, through March 31, 2011. Prenotification occurred in 249 197 EMS-transported patients (67.0%) and varied widely by hospital (range, 0% to 100%). Substantial variations by geographic regions and by state, ranging from 19.7% in Washington, DC, to 93.4% in Montana, also were noted. Patient factors associated with lower use of prenotification included older age, diabetes mellitus, and peripheral vascular disease. Prenotification was less likely for black patients than for white patients (adjusted odds ratio 0.94, 95% confidence interval 0.92-0.97, P<0.0001). Hospital factors associated with greater EMS prenotification use were absence of academic affiliation, higher annual volume of tissue plasminogen activator administration, and geographic location outside the Northeast. Temporal improvements in prenotification rates showed a modest general increase, from 58.0% in 2003 to 67.3% in 2011 (P temporal trend <0.0001). CONCLUSIONS#ENTITYSTARTX02014;: EMS hospital prenotification is guideline recommended, yet among patients transported to Get With The Guidelines-Stroke hospitals it is not provided for 1 in 3 EMS-arriving patients with acute ischemic stroke and varies substantially by hospital, state, and region. These results support the need for enhanced implementation of stroke systems of care. (J Am Heart Assoc. 2012;1:e002345 doi: 10.1161/JAHA.112.002345.).

Keywords: emergency medicine; hospitals; registries; stroke.

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Figures

Figure 1.
Figure 1.
Comparison of EMS prenotification rates by state at the hospital level. States with <4 participating hospitals were excluded.
Figure 2.
Figure 2.
Temporal trends in EMS prenotification, by calendar years, from 2003 to 2011 among patients with acute ischemic stroke transported by EMS. Hospitals N=1585; patients N=371 988. P temporal trend <0.0001.
See this image and copyright information in PMC

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