Olli S Mattila1,2, Tuukka Puolakka3, Juhani Ritvonen2, Saana Pihlasviita2, Heini Harve3, Ari Alanen4, Gerli Sibolt1, Sami Curtze1, Daniel Strbian1, Mikko Pystynen3, Turgut Tatlisumak1,5,6, Markku Kuisma3, Perttu J Lindsberg1,2. 1. 1 Neurology, Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 2. 2 Molecular Neurology, Research Programs Unit, University of Helsinki, Helsinki, Finland. 3. 3 Emergency Medicine and Services, Department of Emergency Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 4. 4 Emergency Response Center Administration, Kerava, Finland. 5. 5 Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg. 6. 6 Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Abstract
BACKGROUND: Accurate identification of acute stroke by Emergency Medical Dispatchers (EMD) is essential for timely and purposeful deployment of Emergency Medical Services (EMS), and a prerequisite for operating mobile stroke units. However, precision of EMD stroke recognition is currently modest. AIMS: We sought to identify targets for improving dispatcher stroke identification. METHODS: Dispatch codes and EMS patient records were cross-linked to investigate factors associated with an incorrect dispatch code in a prospective observational cohort of 625 patients with a final diagnosis of acute stroke or transient ischemic attack (TIA), transported to our stroke center as candidates for recanalization therapies. Call recordings were analyzed in a subgroup that received an incorrect low-priority dispatch code indicating a fall or unknown acute illness (n = 46). RESULTS: Out of 625 acute stroke/TIA patients, 450 received a high-priority stroke dispatch code (sensitivity 72.0%; 95% CI, 68.5-75.5). Independent predictors of dispatcher missed acute stroke included a bystander caller (aOR, 3.72; 1.48-9.34), confusion (aOR, 2.62; 1.59-4.31), fall at onset (aOR, 1.86; 1.24-2.78), and older age (aOR [per year], 1.02; 1.01-1.04). Of the analyzed call recordings, 71.7% revealed targets for improvement, including failure to recognize a Face Arm Speech Time (FAST) test symptom (21/46 cases, 18 with speech disturbance), or failure to thoroughly evaluate symptoms (12/46 cases). CONCLUSIONS: Based on our findings, efforts to improve dispatcher stroke identification should primarily focus on improving recognition of acute speech disturbance, and implementing screening of FAST-symptoms in emergency phone calls revealing a fall or confusion. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov . Unique identifier: NCT02145663.
BACKGROUND: Accurate identification of acute stroke by Emergency Medical Dispatchers (EMD) is essential for timely and purposeful deployment of Emergency Medical Services (EMS), and a prerequisite for operating mobile stroke units. However, precision of EMD stroke recognition is currently modest. AIMS: We sought to identify targets for improving dispatcher stroke identification. METHODS: Dispatch codes and EMS patient records were cross-linked to investigate factors associated with an incorrect dispatch code in a prospective observational cohort of 625 patients with a final diagnosis of acute stroke or transient ischemic attack (TIA), transported to our stroke center as candidates for recanalization therapies. Call recordings were analyzed in a subgroup that received an incorrect low-priority dispatch code indicating a fall or unknown acute illness (n = 46). RESULTS: Out of 625 acute stroke/TIApatients, 450 received a high-priority stroke dispatch code (sensitivity 72.0%; 95% CI, 68.5-75.5). Independent predictors of dispatcher missed acute stroke included a bystander caller (aOR, 3.72; 1.48-9.34), confusion (aOR, 2.62; 1.59-4.31), fall at onset (aOR, 1.86; 1.24-2.78), and older age (aOR [per year], 1.02; 1.01-1.04). Of the analyzed call recordings, 71.7% revealed targets for improvement, including failure to recognize a Face Arm Speech Time (FAST) test symptom (21/46 cases, 18 with speech disturbance), or failure to thoroughly evaluate symptoms (12/46 cases). CONCLUSIONS: Based on our findings, efforts to improve dispatcher stroke identification should primarily focus on improving recognition of acute speech disturbance, and implementing screening of FAST-symptoms in emergency phone calls revealing a fall or confusion. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov . Unique identifier: NCT02145663.
Authors: Amminadab L Eliakundu; Dominique A Cadilhac; Joosup Kim; Monique F Kilkenny; Kathleen L Bagot; Emily Andrew; Shelley Cox; Christopher F Bladin; Michael Stephenson; Lauren Pesavento; Lauren Sanders; Ben Clissold; Henry Ma; Karen Smith Journal: J Am Coll Emerg Physicians Open Date: 2022-07-01
Authors: Pauli E T Vuorinen; Jyrki P J Ollikainen; Pasi A Ketola; Riikka-Liisa K Vuorinen; Piritta A Setälä; Sanna E Hoppu Journal: Scand J Trauma Resusc Emerg Med Date: 2021-07-19 Impact factor: 2.953