The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study.

Sheppard, James P, Mellor, Ruth M, Greenfield, Sheila, Mant, Jonathan, Quinn, Tom, Sandler, David, Sims, Don, Singh, Satinder, Ward, Matthew and McManus, Richard J (2015) The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study. Emergency Medicine Journal, 32(2), pp. 93-99. ISSN (print) 1472-0205

Full text available as:
[img]
Preview
Text
Quinn-T-32891.pdf - Published Version
Available under License Creative Commons Attribution Non-commercial.

Download (1MB) | Preview

Abstract

BACKGROUND: Hospital prealerting in acute stroke improves the timeliness of subsequent treatment, but little is known about the impact of prehospital assessments on in-hospital care. OBJECTIVE: Examine the association between prehospital assessments and notification by emergency medical service staff on the subsequent acute stroke care pathway. METHODS: This was a cohort study of linked patient medical records. Consenting patients with a diagnosis of stroke were recruited from two urban hospitals. Data from patient medical records were extracted and entered into a Cox regression analysis to investigate the association between time to CT request and recording of onset time, stroke recognition (using the Face Arm Speech Test (FAST)) and sending of a prealert message. RESULTS: 151 patients (aged 71±15 years) travelled to hospital via ambulance and were eligible for this analysis. Time of symptom onset was recorded in 61 (40%) cases, the FAST test was positive in 114 (75%) and a prealert message was sent in 65 (44%). Following adjustment for confounding, patients who had time of onset recorded (HR 0.73, 95% CI 0.52 to 1.03), were FAST-positive (HR 0.54, 95% CI 0.37 to 0.80) or were prealerted (HR 0.26, 95% CI 0.18 to 0.38), were more likely to receive a timely CT request in hospital. CONCLUSIONS: This study highlights the importance of hospital prealerting, accurate stroke recognition, and recording of onset time. Those not recognised with stroke in a prehospital setting appear to be excluded from the possibility of rapid treatment in hospital, even before they have been seen by a specialist.

Item Type: Article
Research Area: Health services research
Faculty, School or Research Centre: Faculty of Health, Social Care and Education
Related URLs:
Depositing User: Clive Allnutt
Date Deposited: 09 Nov 2015 14:23
Last Modified: 09 Jun 2016 13:51
URI: http://eprints.kingston.ac.uk/id/eprint/32891

Actions (Repository Editors)

Item Control Page Item Control Page