BACKGROUND: Acute stroke is a time- and expertise-critical emergency. An immediate and correct diagnosis by emergency medical services (EMS) in the prehospital phase and patient transfer to the nearest adequate hospital with a stroke unit is required for early treatment of acute stroke. PATIENTS AND METHODS: We evaluated all patients who were admitted by the EMS of Münster to one of the two stroke units in the town between October 2008 and December 2010 with a diagnosis of acute stroke. Furthermore all patients were critically analyzed who were admitted without a diagnosis of acute stroke by the EMS but nonetheless had a stroke and the correct diagnosis was not found until examination in the neurological department. RESULTS: We analyzed 615 patients who were admitted to the stroke units with the diagnosis of acute stroke. In 561 cases (91%) this diagnosis could be confirmed, but in 54 patients (9%) the diagnosis by the EMS was incorrect. Epileptic seizure was the most frequent false-positive diagnosis in this group of patients (39%; n = 21). Although the acute symptoms were caused by a stroke, the correct diagnosis was not defined by the EMS in 127 patients. This accounted for 18% of all patients admitted to the emergency departments by the EMS where ultimately a stroke was diagnosed. In 24% of these cases (n = 30) the emergency doctor missed the correct diagnosis, which meant 4% of all patients admitted by the EMS, finally diagnosed with an acute stroke. In all other cases in the group with a false-negative diagnosis (76% or 97 patients) an emergency doctor was not involved in the referral by the EMS. CONCLUSION: Emergency medical services should be involved in the establishment of admission programs for acute stroke patients to provide the fastest means of transportation to a stroke unit. Coma, symptoms of posterior cerebral circulation and epileptic seizures cause difficulties in ensuring an immediate and correct diagnosis. Sending an emergency doctor to the scene increases diagnostic certainty which is essential to initiate early treatment.
BACKGROUND:Acute stroke is a time- and expertise-critical emergency. An immediate and correct diagnosis by emergency medical services (EMS) in the prehospital phase and patient transfer to the nearest adequate hospital with a stroke unit is required for early treatment of acute stroke. PATIENTS AND METHODS: We evaluated all patients who were admitted by the EMS of Münster to one of the two stroke units in the town between October 2008 and December 2010 with a diagnosis of acute stroke. Furthermore all patients were critically analyzed who were admitted without a diagnosis of acute stroke by the EMS but nonetheless had a stroke and the correct diagnosis was not found until examination in the neurological department. RESULTS: We analyzed 615 patients who were admitted to the stroke units with the diagnosis of acute stroke. In 561 cases (91%) this diagnosis could be confirmed, but in 54 patients (9%) the diagnosis by the EMS was incorrect. Epilepticseizure was the most frequent false-positive diagnosis in this group of patients (39%; n = 21). Although the acute symptoms were caused by a stroke, the correct diagnosis was not defined by the EMS in 127 patients. This accounted for 18% of all patients admitted to the emergency departments by the EMS where ultimately a stroke was diagnosed. In 24% of these cases (n = 30) the emergency doctor missed the correct diagnosis, which meant 4% of all patients admitted by the EMS, finally diagnosed with an acute stroke. In all other cases in the group with a false-negative diagnosis (76% or 97 patients) an emergency doctor was not involved in the referral by the EMS. CONCLUSION: Emergency medical services should be involved in the establishment of admission programs for acute strokepatients to provide the fastest means of transportation to a stroke unit. Coma, symptoms of posterior cerebral circulation and epilepticseizures cause difficulties in ensuring an immediate and correct diagnosis. Sending an emergency doctor to the scene increases diagnostic certainty which is essential to initiate early treatment.
Authors: Gavin D Perkins; William Boyle; Hannah Bridgestock; Sarah Davies; Zoe Oliver; Sandra Bradburn; Clare Green; Robin P Davies; Matthew W Cooke Journal: Resuscitation Date: 2008-02-20 Impact factor: 5.262
Authors: Werner Hacke; Markku Kaste; Erich Bluhmki; Miroslav Brozman; Antoni Dávalos; Donata Guidetti; Vincent Larrue; Kennedy R Lees; Zakaria Medeghri; Thomas Machnig; Dietmar Schneider; Rüdiger von Kummer; Nils Wahlgren; Danilo Toni Journal: N Engl J Med Date: 2008-09-25 Impact factor: 91.245
Authors: Silke Walter; Panagiotis Kostpopoulos; Anton Haass; Stefan Helwig; Isabel Keller; Tamara Licina; Thomas Schlechtriemen; Christian Roth; Panagiotis Papanagiotou; Anna Zimmer; Julio Viera; Julio Vierra; Heiko Körner; Kathrin Schmidt; Marie-Sophie Romann; Maria Alexandrou; Umut Yilmaz; Iris Grunwald; Darius Kubulus; Martin Lesmeister; Stephan Ziegeler; Alexander Pattar; Martin Golinski; Yang Liu; Thomas Volk; Thomas Bertsch; Wolfgang Reith; Klaus Fassbender Journal: PLoS One Date: 2010-10-29 Impact factor: 3.240
Authors: Martin A Ritter; Stefan Brach; Andreas Rogalewski; Ralf Dittrich; Rainer Dziewas; Birgitta Weltermann; Peter U Heuschmann; Darius G Nabavi Journal: Neurol Res Date: 2007-07 Impact factor: 2.448
Authors: U Harding; A Lechleuthner; M A Ritter; M Schilling; M Kros; M Ohms; A Bohn Journal: Med Klin Intensivmed Notfmed Date: 2012-09-27 Impact factor: 0.840