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. 2025 Jun 13;38(5):622-625.
doi: 10.1080/08998280.2025.2514984. eCollection 2025.

Prehospital notification in acute stroke: a retrospective cohort study

Affiliations

Prehospital notification in acute stroke: a retrospective cohort study

Joshua Kimbrell et al. Proc (Bayl Univ Med Cent). .

Abstract

Background: Emergency medical services (EMS) play a key role in identifying stroke patients and transporting them to specialty care centers. We aimed to quantify the time saved in stroke care by EMS prehospital notification.

Methods: We performed a retrospective cohort study at a large comprehensive stroke center in a major metropolitan system including patients treated between 2021 and 2022. Inclusion criteria were adult patients transported to the hospital by EMS with a discharge diagnosis of stroke or transient ischemic attack (TIA).

Results: A total of 1053 patients were included, of whom 637 (60.5%) received prehospital notification. Prehospital notification was associated with a median 3-minute adjusted decrease in the door-to-computed-tomography (CT) time (median 18 min, 95% confidence interval [CI] 17-19 vs 21 min, 95% CI 20-22). Among patients who received intravenous thrombolysis (IVT), notification was associated with a faster adjusted time-to-IVT (median 52 min, 95% CI 50-56 vs 63 min, 95% CI 56-69). Of those who underwent endovascular thrombectomy (EVT), notification was associated with faster unadjusted time-to-EVT (median 97 min, 95% CI 93-105 vs 107 min, 95% CI 97-126), but this difference was no longer significant after adjustment.

Conclusions: Prehospital notification is associated with reduced door-to-CT and door-to-IVT times. Prehospital notification in nationwide quality improvement efforts may improve stroke care.

Keywords: Notification; paramedics; prehospital; stroke; systems of care.

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Conflict of interest statement

Dr. Mac Grory reports grants from the National Institutes of Health outside the submitted work. The authors report no conflict of interest.

Figures

Figure 1.
Figure 1.
Results of adjusted Cox regression models comparing (a) time to computed tomography (CT) and (b) time to intravascular thrombolytic (IVT) among patients who had a prehospital notification and those who did not. Results from the adjusted regression indicate prehospital notification was associated with decreased time-to-CT and time-to-IVT.

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