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

Sheppard, JP, Mellor, RM, Greenfield, S, Mant, J, Quinn, T, Sandler, D, Sims, D, Singh, S, Ward, M and McManus, J (2013) The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study. Emergency Medicine Journal.

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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
Divisions : Faculty of Health and Medical Sciences > School of Health Sciences
Authors :
AuthorsEmailORCID
Sheppard, JPUNSPECIFIEDUNSPECIFIED
Mellor, RMUNSPECIFIEDUNSPECIFIED
Greenfield, SUNSPECIFIEDUNSPECIFIED
Mant, JUNSPECIFIEDUNSPECIFIED
Quinn, TUNSPECIFIEDUNSPECIFIED
Sandler, DUNSPECIFIEDUNSPECIFIED
Sims, DUNSPECIFIEDUNSPECIFIED
Singh, SUNSPECIFIEDUNSPECIFIED
Ward, MUNSPECIFIEDUNSPECIFIED
McManus, JUNSPECIFIEDUNSPECIFIED
Date : 7 October 2013
Identification Number : 10.1136/emermed-2013-203026
Additional Information : This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/
Depositing User : Symplectic Elements
Date Deposited : 27 Aug 2014 14:12
Last Modified : 13 Sep 2014 01:34
URI: http://epubs.surrey.ac.uk/id/eprint/805308

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