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

Sheppard, James P and Mellor, Ruth M and Greenfield, Sheila and Mant, Jonathan and Quinn, Tom and Sandler, David and Sims, Don and Singh, Satinder and 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 : EMJ, 32 (2). pp. 93-9. ISSN 1472-0213.

Full text not available from this repository.
Official URL: http://emj.bmj.com/content/early/2013/10/07/emerme...

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
Subjects: WL Nervous system. Neurology
Divisions: Emergency Services > Acute Medicine and AMU
Related URLs:
Depositing User: Miss Adele Stanton
Date Deposited: 30 May 2015 08:30
Last Modified: 30 May 2015 08:30
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/897

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