Introduction: It is well documented that a Prehospital Stroke Alert (PHSA) protocol leads to decreased treatment times for stroke patients. Outcomes measured typically include Door to Physician (DTP), Door to CT (DTCT), and Door to Needle (DNT) times. Our comprehensive stroke center’s PHSA system has been in place since 2012. This study evaluates 3 specific endpoints. First, Emergency Medical Services (EMS) improve their recognition of stroke symptoms as they gain experience with PHSA. Second, a PHSA protocol decreases intervention times of DTP, DTCT, and DNT over a study period of 3 years. Third, when patients present to our Neurologic Emergency Department (Neuro ED) as a PHSA, rather than a non-PHSA, the intervention times are markedly decreased, and acute ischemic stroke care is significantly expedited.
Methods: A retrospective chart review was conducted for patients who presented to our hospital with an admitting diagnosis of stroke from 2012-2014. Patients were screened for presentation to the Neuro ED and further stratified based on whether a PHSA was called. PHSA was called if EMS deemed the patient’s Cincinnati Stroke Scale score as positive, and symptom onset was within 6 hours. We recorded DTCT, DTP, and DTN times over the years for all patients meeting these inclusion criteria.
Results: Three hundred and five patients with an admission diagnosis of stroke were seen in the Neuro ED (Hours are 0700-1800, 7 days a week) from 2012 to 2014, 128 of which presented as PHSAs. EMS responders accurately diagnosed stroke in 82% of cases. Previously, EMS assessment of stroke was accurate only 66% of the time. PHSA patients had decreased DTP, DTCT, and DTN times over the 3 year period. When comparing the PHSA group to non-PHSA group, statistically significant differences were found in DTP and DTCT times within each year (p≤0.0001).
Discussion: In conclusion, gaining experience with a PHSA protocol did in fact lead to EMS better recognizing stroke symptoms, reduction in the times of delivery of care for acute ischemic stroke patients over the years 2012-2014, and a markedly statistically significant difference in intervention times if patients were seen as a PHSA as opposed to a non-PHSA.