Background: The occurrence of stroke during driving motor vehicles “stroke on wheels” and unique consideration pertaining to such an event are not well recognized.
Methods: The data from the National Emergency Department Sample (NEDS) 2013-2014 was analyzed to generate national estimates of “stroke on wheels”. The NEDS contains data for emergency department (ED) visits from ≈1000 hospitals located in 33 States and the District of Columbia, approximating a 20-percent stratified sample of U.S. hospital-based ED visits. We also compared the demographic, clinical, and treatment characteristics of patients with “stroke on wheels” and those with other form of strokes.
Results: A total of 1164 (0.06%) of 1,805,447 patients with stroke experienced “stroke on wheels”. Patients with “stroke on wheels” were less likely to be aged ≥80 years (17.2% versus 28.6%, p<0.001) and more likely to be men (66.3% versus 47.5%, p<0.001). The primary payer type was private insurance including HMO in patients with “stroke on wheels” (49.1% versus 19.5%, p<0.001). Patients with “stroke on wheels” were more likely to have atrial fibrillation (20.8% versus 17.3%, p=0.001) and previous stroke (16.3% versus 10.7%, p<0.001). The rate of ischemic stroke (70.5% versus 52.0%, p<0.001) was higher among patients with "stroke on wheels". There was no difference in the rate of utilization of intravenous thrombolysis in ischemic stroke patients with “stroke on wheels” and those with other form of strokes. Patients with “stroke on wheels” were more likely to be admitted to the same hospital (83% versus 71.7%, p,0.001) and subsequently discharged with none to minimal disability (53.7% versus 44%, p<0.001). In regard to injury sustained, patients with “stroke on wheels”, International Classification of Disease Program for Injury Categorization score of 1-10, 11-20, and >20 were seen in 40%, 2.3%, and 1.2% of patients, respectively.
Conclusions: We present the unique attributes of occurrence of “stroke on wheels” to enable greater recognition and appropriate triage.