• Tue. Sep 27th, 2022

Analysis of Stroke Care Among National Emergency Medical Services Information System Encounters 2019-2020

This article was originally published here

J Stroke Cerebrovascular Dis. 2022 Jan 5;31(3):106278. doi: 10.1016/j.jstrokecerebrovasdis.2021.106278. Online ahead of print.

ABSTRACT

OBJECTIVES: Emergency medicine service (EMS) providers play a central role in the early identification and initiation of treatment for stroke. The objective of this study is to characterize nationwide EMS practices for presumptive stroke and to assess gender-based differences according to American Stroke Association (ASA) guidelines.

MATERIALS AND METHODS: Using the 2019-2020 National Emergency Medical Services Information System (NEMSIS) datasets, we identified encounters with an EMS-designated stroke primary impression. We characterized patient characteristics and EMS practices and assessed compliance with eight ‘guideline-consistent’ parameters of care. Multivariate logistic regression modeled the association between gender and primary outcome (guideline-compliant care), adjusted for age, EMS service level, EMS geographic region, type of region (c’ i.e. urban or rural) and year.

RESULTS: Across 693,177 encounters with a primary impression of stroke, overall compliance with each performance measure ranged from 18% (providing supplemental oxygen when pulse oximetry is less than 94%) to 76% (less 90 seconds between the incoming call and the sending of the SMU) . 2,382 (0.39%) consultations were fully compliant with guidelines. Women were significantly less likely than men to receive guideline-compliant care (adjusted OR 0.82, 95% CI 0.75-0.89; 0.36% women, 0.43% men with guideline care).

CONCLUSIONS: A minority of patients received prehospital stroke care that was documented to be consistent with ASA guidelines. Women were less likely to receive fully compliant care than men, after controlling for confounders, although the difference was small and of uncertain climatic significance. Further studies are needed to assess the underlying reasons for this disparity, its impact on patient outcomes, and to identify potential targeted interventions to improve prehospital stroke care.

PMID:34998044 | DOI:10.1016/j.jstrokecerebrovasdis.2021.106278