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Benefits of Prehospital Notification for Stroke Patients

Prehospital ED notification decreased door-to-CT time by 23% and doubled use of thrombolytic therapy.

Early identification and management of acute stroke are critical for improving outcomes. To examine the effects of advance notification of the arrival of stroke patients, researchers retrospectively analyzed data for 118 patients with acute stroke who were transported by emergency medical services directly from the scene to a single tertiary care emergency department within 6 hours of symptom onset during a 16-month period.

EMS staff provided advance notification to ED staff for 44 patients. No significant differences in age, sex, stroke history, or median National Institutes of Health Stroke Scale scores were noted between patients for whom prehospital notification was and was not given. Prehospital notification was associated with significantly shorter door-to-computed tomography (CT) time than no prehospital notification (median time, 40 vs. 47 minutes). In multivariable linear regression modeling, prehospital notification reduced door-to-CT time by 23%. Nine patients for whom prehospital notification was given and none for whom notification was not given had prolonged door-to-CT times (2–5 hours). All patients were evaluated by a vascular neurologist. Overall, 29% of patients received thrombolytic therapy (intravenous tissue plasminogen activator [TPA] in 20; IV TPA followed by intra-arterial thrombolysis in 12; and intra-arterial thrombolysis alone in 2). Patients who arrived at the ED after prehospital notification were twice as likely as those who arrived without advance notice to receive thrombolytic therapy (42% vs. 21%).

Comment: As expected, analogous to prehospital activation of the cath lab for patients with ST-segment-elevation myocardial infarction, prehospital notification of the ED allows mobilization of hospital resources for incoming stroke patients. Prehospital notification for stroke already is a class I recommendation of the American Heart Association. Why advance notification was not given for 63% of patients in this study is not known. Most disturbing is that even when advance notification was provided, patients did not get CT scans within the recommended 30 minutes. Although the window of time for stroke treatment is widening to 4.5 hours (JW Emerg Med Sep 15 2008 and Sep 24 2008), that is not a license for delay. Time to CT is a key driver of rapid thrombolytic therapy and requires close attention.

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine November 7, 2008

Citation(s):

Abdullah AR et al. Advance hospital notification by EMS in acute stroke is associated with shorter door-to-computed tomography time and increased likelihood of administration of tissue-plasminogen activator. Prehosp Emerg Care 2008 Oct-Dec; 12:426.

• Medline abstract (Free)