Aliza T Brown1, Feifei Wei2, William C Culp1, Greg Brown3, Ryan Tyler3, Appathurai Balamurugan4, Nicolas Bianchi5. 1. Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205. 2. Department of Biostatistics, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205. 3. Arkansas Department of Health, Section of Emergency Medical Services, Little Rock, AR 72204. 4. Arkansas Department of Health, Chronic Disease Prevention and Control Branch, Little Rock, AR 72204. 5. Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR 72205. Electronic address: nicolas.a.bianchi@emory.edu.
Abstract
INTRODUCTION: Time delay is the key obstacle for receiving successful stroke treatment. Alteplase therapy must start within 4.5 hours from stroke occurrence. Rapid transport to a primary stroke center (PSC) or acute stroke-ready hospital (ASRH) by the emergency medical system (EMS) paramedics is vital. We determined transport time and destination data for EMS-identified and -delivered stroke suspects in Arkansas during 2013. Our objective was to analyze transport time and the hospital qualification for stroke care across the state. METHODS: The state's 75 counties were placed into 8 geographical regions (R1-R8). Transport time and hospital qualification were determined for all EMS-identified strokes. Each hospital's stroke care status was categorized as PSC, ASRH, a nonspecialty or unknown care facility (NSCF), out-of-state, or nonapplicable designation facilities. RESULTS: There were 9588 EMS stroke ground transports with median within-region transport times of 29-40 minutes. Statewide, only 65% of EMS-transported stroke patients were transported to either PSC (12%) or ASRH (53%) facilities. One-third of the patients (30.6%) were delivered to NSCFs, where acute stroke therapy may rarely be performed. Regions with the highest suspected-stroke cases per capita also had the highest percentage of transports to NSCFs. CONCLUSION: With only a few PSCs in Arkansas, EMS agencies should prioritize transporting stroke patients to ASRHs when PSCs are not regionally located.
INTRODUCTION: Time delay is the key obstacle for receiving successful stroke treatment. Alteplase therapy must start within 4.5 hours from stroke occurrence. Rapid transport to a primary stroke center (PSC) or acute stroke-ready hospital (ASRH) by the emergency medical system (EMS) paramedics is vital. We determined transport time and destination data for EMS-identified and -delivered stroke suspects in Arkansas during 2013. Our objective was to analyze transport time and the hospital qualification for stroke care across the state. METHODS: The state's 75 counties were placed into 8 geographical regions (R1-R8). Transport time and hospital qualification were determined for all EMS-identified strokes. Each hospital's stroke care status was categorized as PSC, ASRH, a nonspecialty or unknown care facility (NSCF), out-of-state, or nonapplicable designation facilities. RESULTS: There were 9588 EMS stroke ground transports with median within-region transport times of 29-40 minutes. Statewide, only 65% of EMS-transported strokepatients were transported to either PSC (12%) or ASRH (53%) facilities. One-third of the patients (30.6%) were delivered to NSCFs, where acute stroke therapy may rarely be performed. Regions with the highest suspected-stroke cases per capita also had the highest percentage of transports to NSCFs. CONCLUSION: With only a few PSCs in Arkansas, EMS agencies should prioritize transporting strokepatients to ASRHs when PSCs are not regionally located.
Authors: T J Crocco; J C Grotta; E C Jauch; S E Kasner; R U Kothari; B R Larmon; J L Saver; M R Sayre; S M Davis Journal: Prehosp Emerg Care Date: 2007 Jul-Sep Impact factor: 3.077
Authors: Craig D Newgard; N Clay Mann; Renee Y Hsia; Eileen M Bulger; O John Ma; Kristan Staudenmayer; Jason S Haukoos; Ritu Sahni; Nathan Kuppermann Journal: Acad Emerg Med Date: 2013-09 Impact factor: 3.451
Authors: Dariush Mozaffarian; Emelia J Benjamin; Alan S Go; Donna K Arnett; Michael J Blaha; Mary Cushman; Sarah de Ferranti; Jean-Pierre Després; Heather J Fullerton; Virginia J Howard; Mark D Huffman; Suzanne E Judd; Brett M Kissela; Daniel T Lackland; Judith H Lichtman; Lynda D Lisabeth; Simin Liu; Rachel H Mackey; David B Matchar; Darren K McGuire; Emile R Mohler; Claudia S Moy; Paul Muntner; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Graham Nichol; Latha Palaniappan; Dilip K Pandey; Mathew J Reeves; Carlos J Rodriguez; Paul D Sorlie; Joel Stein; Amytis Towfighi; Tanya N Turan; Salim S Virani; Joshua Z Willey; Daniel Woo; Robert W Yeh; Melanie B Turner Journal: Circulation Date: 2014-12-17 Impact factor: 29.690
Authors: T I Gropen; P J Gagliano; C A Blake; R L Sacco; T Kwiatkowski; N J Richmond; D Leifer; R Libman; S Azhar; M B Daley Journal: Neurology Date: 2006-07-11 Impact factor: 9.910
Authors: Andrew W Asimos; Shana Ward; Jane H Brice; Dianne Enright; Wayne D Rosamond; Larry B Goldstein; Jonathan Studnek Journal: J Stroke Cerebrovasc Dis Date: 2014-10-05 Impact factor: 2.136
Authors: Haroon Chughtai; Douglas Ratner; Mario Pozo; Joseph A Crouchman; Barbara Niedz; Richard Merwin; Robert G Lahita Journal: Am J Emerg Med Date: 2010-04-02 Impact factor: 2.469
Authors: Harold P Adams; Gregory del Zoppo; Mark J Alberts; Deepak L Bhatt; Lawrence Brass; Anthony Furlan; Robert L Grubb; Randall T Higashida; Edward C Jauch; Chelsea Kidwell; Patrick D Lyden; Lewis B Morgenstern; Adnan I Qureshi; Robert H Rosenwasser; Phillip A Scott; Eelco F M Wijdicks Journal: Circulation Date: 2007-05-22 Impact factor: 29.690