Introduction: Utilization of EMS is associated with faster emergency department evaluation and treatment of patients with stroke, especially among EMS-recognized patients. However, most research focuses on patients with ischemic stroke. We sought to identify factors associated with prehospital recognition of hemorrhagic stroke and the impact of recognition on prehospital and in-hospital care.
Methods: A cohort of hospital-confirmed hemorrhagic stroke cases transported by EMS to 2 primary stroke centers in Kent County, Michigan over a 12-month time period was assembled. Data regarding prehospital care (Cincinnati stroke screen [CPSS] documentation, GCS, clinical signs and symptoms, transportation times, and paramedic impression) were linked to in-hospital data on door-to-CT (DTCT) times, mortality, and discharge disposition. We examined the relationships between clinical factors and stroke recognition by paramedics as well as between recognition and in-hospital outcomes.
Results: Over 12 months, 73 confirmed hemorrhagic stroke patients arrived by EMS. Forty-seven (64.4%) were correctly identified by EMS as stroke; 26 (35.6%) were missed. EMS recognition was associated with greater likelihood CPSS documentation, intracerebral hemorrhage, dispatch impression of stroke, absence of seizure, and higher systolic blood pressure (Table). Multiple logistic regression confirmed a strong independent relationship between CPSS documentation and stroke recognition (OR 40.3 [5.0 to 323.5]). EMS recognized cases had shorter on-scene times (17 vs. 21 minutes, p=0.004), total transport times (33 vs. 43 minutes, p=0.003), and DTCT times (30 vs. 48 minutes, p=0.004). Recognition was not associated with mortality or discharge disposition.
Conclusion: CPSS documentation is strongly associated with hemorrhagic stroke recognition by EMS providers. EMS recognition is associated with more efficient transportation and faster DTCT times upon hospital arrival.