Circ: Stroke outcomes better when EMS notifies hospital

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When emergency medical services (EMS) notifies the hospital of a potential stroke patient before the patient reaches its doors, outcomes improve, according to a study published online July 10 in Circulation: Cardiovascular Quality and Outcomes.

“The benefits of intravenous tissue-plasminogen activator (tPA) in acute ischemic stroke are time-dependent,” Cheryl B. Lin, BS, of the Duke-National University of Singapore Graduate Medical School in Singapore, and colleagues wrote. “EMS hospital prenotification of an incoming patient with potential stroke may provide a means of reducing evaluation and treatment times and improving treatment rates; yet, available data are limited.”

To bolster these data, Lin et al evaluated records of 371,988 patients with acute ischemic stroke who were transported via EMS and enrolled in the Get With the Guidelines—Stroke database between April 1, 2003, and March 31, 2011. The authors noted that prenotification occurred in 67 percent of EMS-transported patients.

For patients who arrived within two hours, patients with EMS prenotification were more likely to be treated with tPA within three hours, 82.8 percent vs. 79.2 percent, respectively.

The researchers said that EMS prenotification patients had shorter door-to-imaging times, shorter door-to-needle times and shorter symptom onset-to-needle times. Additionally, a multivariable analysis showed an independent association between EMS prenotification and door-to-imaging times of less than 25 minutes, door-to-needle times for tPA of less than 60 minutes and an onset-to-needle times of less than or equal to 120 minutes.

“Our analysis supports the role of EMS prenotification as a potentially important but underused means to improving rapid triage, evaluation and treatment of patients with acute ischemic stroke,” the authors wrote. While many benefits have been linked to the administration of tPA for acute stroke, many hospitals still have difficulty meeting these performance goals, leaving room for improvement within the healthcare system.

“Identifying and implementing effective strategies to facilitate the rapid evaluation and treatment of patients with acute ischemic stroke is critical,” the authors wrote. “Prearrival notification is one such strat­egy, and prior studies have suggested that this approach may facilitate more timely stroke evaluation and care.”

The authors said local, regional and national initiatives are needed to help improve stroke care and outcomes. “Increasing the portion of patients evaluated and treated with tPA in a timely fashion requires a systems approach that is operative at three major levels,” Lin et al wrote.

These levels are:

  • Increasing patients' stroke symptom recognition and active activation of EMS;
  • Adequate training of EMS staff in the proper use of stroke screening instruments for timely identification of ischemic stroke; and
  • Community initiatives to inform the public of the benefits associated with EMS use.

“Appropriate response within hospital facilities is necessary to derive the benefits of EMS prenotification,” the authors summed. Improving EMS prenotification rates will help improve acute ischemic stroke outcomes on a national level, they added.