Introduction and objectives: Ambulance usage is the most important factor resulting in shorter time to hospital arrival in adult stroke. Prenotification and bypass to stroke centres are associated with increased thrombolysis rates. Sensitivity of paramedic stroke identification in adults varies from 44-66% but there are no published data in children.
Hypotheses and aims: We hypothesised that emergency medical services call-taker (EMSDCT) and paramedic identification of childhood arterial ischemic stroke (AIS) is suboptimal and contributes to prehospital delays. Our aims were to determine sensitivity of EMSCT and paramedic diagnosis, and to describe patterns and timelines of paramedic care in childhood AIS.
Methods: Retrospective study of ambulance transported children <18 years with radiologically confirmed AIS, from 2008-2015. Direct admissions to inpatient units were excluded.
Results: Ambulance records were reviewed for 19 children. Four children were excluded because records were unavailable. 58% were female, median age was 8 years (IQR 3-14) and median PedNIHSS score was 8 (IQR 3-16). EMSCT diagnosis was stroke in 21% of children and Code 1 (lights and sirens) ambulance were dispatched for 72% of children. Paramedic diagnosis was stroke in 26% of children. Prenotification occurred in 42% of children and 64% were transported to adult (6) or pediatric (6) hospitals meeting criteria for primary stroke centres. Median prehospital timelines were: onset to 911 call 13 minutes, call to scene 12 minutes, time at scene 14 minutes, call to ED arrival 54 minutes, and total pre-hospital lag time 71 minutes (IQR 60-85). In contrast post-arrival lag time to radiological confirmation of diagnosis was 568 minutes (IQR 144-799).
Conclusion: Sensitivity of EMSCT and paramedic childhood AIS diagnosis and pre-notification rates are much lower than those reported in adults. However prehospital factors contribute less to delayed diagnosis than in hospital factors, representing an important difference to adult stroke.