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. 2019 Jan 9;27(1):3.
doi: 10.1186/s13049-018-0580-4.

Pre-hospital management of acute stroke patients eligible for thrombolysis - an evaluation of ambulance on-scene time

Nicolas Drenck  1 , Søren Viereck  2 , Josefine Stokholm Bækgaard  2 , Karl Bang Christensen  3 , Freddy Lippert  2 , Fredrik Folke  2   4
Affiliations

Pre-hospital management of acute stroke patients eligible for thrombolysis - an evaluation of ambulance on-scene time

Nicolas Drenck et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Stroke is a leading cause of death and disability with effective treatment, including thrombolysis or thrombectomy, being time-critical for favourable outcomes. While door-to-needle time in hospital has been optimized for many years, little is known about the ambulance on-scene time (OST). OST has been reported to account for 44% of total alarm-to-door time, thereby being a major time component. We aimed to analyse ambulance OST in stroke patients eligible for thrombolysis and identify potential areas of time optimization.

Methods: A study-specific registration form was developed to record detailed information about OST consumption in cases where the Emergency Medical Services (EMS) suspected a stroke from July 2014-May 2015. Registration forms were completed by ambulance personnel and included details on estimated time spent: 1) localising patient, 2) clinical examination, 3) consulting with the on-call neurologist, 4) mobilising patient to the ambulance, 5) treatment in ambulance before departure. Additionally, estimated total OST was noted. For patients found eligible for further evaluation at a stroke centre, time points were analysed using multivariate Poisson regressions.

Results: A total of 520 cases were included. The median OST was 21 min (Interquartile Range (IQR) 16-27). Time consumption was significantly lower (17 vs 21 min, p = 0.0015) when electrocardiography (ECG) was obtained in-hospital instead of on-scene, when intravenous (IV) access was established during transportation instead of before transportation (17 vs 21 min, p < 0.0001), and when the quality of communication with the stroke centres was rated as "good" as opposed to "acceptable/poor" (21 vs 23 min, p = 0.014). Neither the presence of relatives nor ambulance trainees had a significant effect on OST.

Conclusions: In-hospital ECG recording and IV cannulation during transport were found to reduce OST, while "acceptable/poor" communication was found to prolong OST relative to "good" communication. These components of pre-hospital stroke management represent potential opportunities for lowering OST with relatively simple changes, which could ultimately lead to earlier treatment and better patient outcome.

Trial registration: Unique identifier: NCT02191514 .

Keywords: Cerebrovascular disease; Emergency medical services; Ischemic stroke; Pre-hospital delay; Pre-hospital stroke management; Stroke; Stroke on-scene time; Thrombolysis.

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Conflict of interest statement

Ethics approval and consent to participate

Approval from the Danish Data Protection Agency (2007-58-0015) was obtained. Approval from the regional ethics committee was not required (H-4-2014-FSP).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Page 1 and page 2 of the registration form used for data collection
Fig. 2
Fig. 2
Flowchart depicting the reasons for exclusion of registration forms. Patients considered not eligible for evaluation at the stroke center were excluded. However, no reasons for non-eligibility were recorded
See this image and copyright information in PMC

References

    1. WHO. The top 10 causes of death. Available from: http://www.who.int/gho/mortality_burden_disease/causes_death/top_10/en/. Accessed 29th October 2018.
    1. Centers for Disease Control and Prevention. Stroke Fact Sheet. Available from: https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_stroke.htm. Accessed 29th October 2018.
    1. Dansk Selskab for Apopleksi. Referenceprogram for behandling af patienter med apopleksi 2012. Available from: http://www.dsfa.dk/wp-content/uploads/REFERENCEPROGRAMFINAL20131.pdf. Accessed: 27th October 2018.
    1. Saver JL. Time is brain--quantified. Stroke. 2006;37(1):263–266. doi: 10.1161/01.STR.0000196957.55928.ab. - DOI - PubMed
    1. Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317–1329. doi: 10.1056/NEJMoa0804656. - DOI - PubMed

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