Tuure Varjoranta1, Lasse Raatiniemi2, Kari Majamaa3, Matti Martikainen4, Janne H Liisanantti4. 1. Research Unit of Surgery, Anesthesiology and Intensive Care, Oulu University, Oulu, Finland; Research Unit of Clinical Neurosciences, University of Oulu, Oulu, Finland. 2. Research Unit of Surgery, Anesthesiology and Intensive Care, Oulu University, Oulu, Finland; Centre for Pre-Hospital Emergency Care, Oulu University Hospital, Oulu, Finland. 3. Research Unit of Clinical Neurosciences, University of Oulu, Oulu, Finland; Medical Research Center, Neurology, Oulu University Hospital, Oulu, Finland. 4. Research Unit of Surgery, Anesthesiology and Intensive Care, Oulu University, Oulu, Finland.
Abstract
BACKGROUND: Thrombolysis improves stroke outcome, but efficacy of the treatment is limited by time. Therefore, recognition of stroke symptoms by dispatch centres and by emergency medical services (EMS) is crucial, as is minimization of pre-hospital delays. We investigated the pre-hospital delays in patients with stroke treated with thrombolysis and compared the delays between rural and urban patients. METHODS: Patients that had received thrombolysis at Oulu University Hospital (OUH) between 1 January 2013 and 31 December 2015 were identified. Patients were divided into urban and rural based on the site of the EMS mission. Pre-hospital charts and medical records were reviewed. Onset-to-dispatch, dispatch-to-arrival of EMS, on-scene, transport and door-to-needle times were studied. RESULTS: Three hundred one stroke patients were treated with thrombolysis at OUH, and 232 of them were included in the study. Positive Face Arm Speech Test (FAST) findings, priority dispatch code and transport code were associated with shorter transport delays. The priority dispatch was not used in 12.5% of stroke patients treated with thrombolysis. The rural patients had a four minutes longer dispatch-to-arrival delay and 50 (34, 74) minutes longer transport time. The door-to-needle time was 8 (5, 14) minutes shorter in rural patients than in urban patients. CONCLUSIONS: Positive FAST findings and the use of priority dispatch code and priority transport code were associated with shorter transport delays. There is room for improvement in door-to-needle time and in stroke recognition by the dispatch centre and EMS providers. For the rural population, helicopter transportation could reduce the long pre-hospital time.
BACKGROUND: Thrombolysis improves stroke outcome, but efficacy of the treatment is limited by time. Therefore, recognition of stroke symptoms by dispatch centres and by emergency medical services (EMS) is crucial, as is minimization of pre-hospital delays. We investigated the pre-hospital delays in patients with stroke treated with thrombolysis and compared the delays between rural and urban patients. METHODS:Patients that had received thrombolysis at Oulu University Hospital (OUH) between 1 January 2013 and 31 December 2015 were identified. Patients were divided into urban and rural based on the site of the EMS mission. Pre-hospital charts and medical records were reviewed. Onset-to-dispatch, dispatch-to-arrival of EMS, on-scene, transport and door-to-needle times were studied. RESULTS: Three hundred one strokepatients were treated with thrombolysis at OUH, and 232 of them were included in the study. Positive Face Arm Speech Test (FAST) findings, priority dispatch code and transport code were associated with shorter transport delays. The priority dispatch was not used in 12.5% of strokepatients treated with thrombolysis. The rural patients had a four minutes longer dispatch-to-arrival delay and 50 (34, 74) minutes longer transport time. The door-to-needle time was 8 (5, 14) minutes shorter in rural patients than in urban patients. CONCLUSIONS: Positive FAST findings and the use of priority dispatch code and priority transport code were associated with shorter transport delays. There is room for improvement in door-to-needle time and in stroke recognition by the dispatch centre and EMS providers. For the rural population, helicopter transportation could reduce the long pre-hospital time.
Authors: Elizabeth Parody-Rua; Alejandro Bustamante; Joan Montaner; Maria Rubio-Valera; David Serrano; Soledad Pérez-Sánchez; Alba Sánchez-Viñas; César Guevara-Cuellar; Antoni Serrano-Blanco Journal: Eur J Health Econ Date: 2022-07-27