Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May-Jun;24(3):319-325.
doi: 10.1080/10903127.2019.1662862. Epub 2019 Oct 2.

The Association between Presentation by EMS and EMS Prenotification with Receipt of Intravenous Tissue-Type Plasminogen Activator in a State Implementing Stroke Systems of Care

Victoria M Nielsen, Claudine DeJoie-Stanton, Glory Song, Anita Christie, Jing Guo, Kori Sauser Zachrison

The Association between Presentation by EMS and EMS Prenotification with Receipt of Intravenous Tissue-Type Plasminogen Activator in a State Implementing Stroke Systems of Care

Victoria M Nielsen et al. Prehosp Emerg Care. 2020 May-Jun.

Abstract

Introduction: Collaboration between emergency medical services (EMS) and hospitals receiving stroke patients is critical to ensure prompt, effective treatment, and is a key component of the stroke systems of care (SSoC). The goal of our study was to evaluate the association between presentation by EMS and EMS prenotification with odds of receiving Tissue-type Plasminogen Activator (IV-tPA) in a state implementing SSoC while rigorously accounting for missing data. Methods: We utilized data from the Massachusetts Paul Coverdell Stroke Registry for this study, and analyzed adult patients presenting with ischemic stroke to Massachusetts Coverdell hospitals between 2016 and 2018. Patients with contraindications to IV-tPA were excluded. We used generalized estimating equations to assess associations between presentation by EMS, EMS prenotification, and receipt of IV-tPA. We also performed a sensitivity analysis using multiple imputation to assess the sensitivity of our findings to missing data. Results: We identified 9,230 eligible patients with ischemic stroke during the study period. In multivariate complete case regressions, presentation by EMS and EMS prenotification were associated with statistically significant increased odds of receiving IV-tPA (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.28-1.80, p-value < 0.01; OR 1.75, 95% CI 1.36-2.24, p-value < 0.01, respectively). Analysis of imputed data indicated level or stronger associations. Conlcusion: Our analysis indicates that presentation by EMS and EMS prenotification are associated with increased odds of receiving IV-tPA in a state implementing the SSoC. Our results lend importance to the critical role of EMS in the SSoC. Future interventions should work to increase rates of prenotification by EMS and assess inequities in receipt of IV-tPA.

Keywords: delivery of health care; emergency medical services; stroke.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure 1.
Figure 1.
Consort Flow Diagram
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Marler JR, Tilley BC, Lu M, Brott TG, Lyden PC, Grotta JC, Broderick JP, Levine SR, Frankel MP, Horowitz SH, Haley ECJ, Lewandowski CA, Kwiatkowski TPMarler JR, Tilley BC, Lu M, Brott TG, Lyden PC, Grotta JC, Broderick JP, Levine SR, Frankel MP, Horowitz SH, Haley ECJ, Lewandowski CA, Kwiatkowski TP. Early stroke treatment associated with better outcome: The NINDS rt-PA Stroke Study. Neurology. 2012;55(11): 1649–55. - PubMed
    1. Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EFMAdams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EFM. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council. Circulation. 2007;115:e478–534. - PubMed
    1. Messé SR, Khatri P, Reeves MJ, Smith EE, Saver JL, Bhatt DL, Grau-Sepulveda MV, Cox M, Peterson ED, Fonarow GC, Schwamm LHMessé SR, Khatri P, Reeves MJ, Smith EE, Saver JL, Bhatt DL, Grau-Sepulveda MV.,Cox M, Peterson ED, Fonarow GC, Schwamm LH. Why are acute ischemic stroke patients not receiving IV tPA? Neurology. 2016;87(15): 1565–74. - PMC - PubMed
    1. Reed SD, Cramer SC, Blough DK, Meyer K, Jarvik JGReed SD, Cramer SC, Blough DK, Meyer K, Jarvik JG. Treatment With Tissue Plasminogen Activator and Inpatient Mortality Rates for Patients With Ischemic Stroke Treated in Community Hospitals. Stroke. 2001;32:1832–40. - PubMed
    1. Katzan IL, Hammer MD, Hixson ED, Furlan AJ, Abou-Chebl A, Nadzam DMKatzan IL, Hammer MD, Hixson ED, Furlan AJ, Abou-Chebl A, Nadzam DM. Utilization of Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke. Arch Neurol. 2004;61(3):346. - PubMed

Publication types

Substances