Pre-hospital stroke alerts expedite CT imaging

The use of pre-hospital stroke alerts by emergency medical services (EMS) may mean patients can get life-saving treatment faster. A study published in the March issue of Neurosurgery found that EMS personnel who identified patients having strokes and notified hospitals allowed patients to skip the emergency department and have a CT scan as soon as possible.

Mandy J. Binning, MD, of Capital Institute for Neurosciences in Pennington, N.J., evaluated the impact of pre-hospital stroke alerts (PHSAs) on door-to-CT time and time to initiation of tissue plasminogen activator (tPA), also known as door-to-needle time. EMS personnel were trained in advanced stroke life support and recognizing stroke. The protocol consisted of EMS identification of stroke symptoms within six hours and notification of the hospital that a possible stroke patient was en route.

The emergency department then notified appropriate staff of the incoming patient and neurological staff waited for the patient in CT. After the CT, the neurologist in the emergency department determined whether tPA was warranted.

Study patients were all 18 or older and were identified as PHSAs between 2012 and 2013. During that time, the emergency department received 141 PHSAs determined to be stable enough to go directly to CT. EMS was accurate in assessing stroke 66 percent of the time. The average door-to-CT time was 11.8 minutes, which was a considerable decrease from the pre-PHSA time of 35 minutes. Of the 26 patients who received tPA, average door-to-needle time was 57 minutes, also considerably lower than the pre-PHSA time of 99 minutes.

In an accompanying comment, Ning Lin, MD, and Adnan Siddiqui, MD, of University at Buffalo Neurosurgery in Buffalo, N.Y., wrote that Binning et al’s findings support "a specialized triage system for patients who have acute stroke that can be initiated by EMS in the field and bypass the emergency department unless additional hemodynamic or respiratory concerns need to be addressed emergently.”