Amminadab L Eliakundu1, Dominique A Cadilhac2, Joosup Kim2, Nadine E Andrew3, Christopher F Bladin4, Rohan Grimley5, Helen M Dewey6, Geoffrey A Donnan7, Kelvin Hill8, Christopher R Levi9, Sandy Middleton10, Craig S Anderson11, Natasha A Lannin12, Monique F Kilkenny13. 1. Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia. 2. Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia. 3. Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia. 4. Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Ambulance Victoria, Doncaster, Victoria, Australia. 5. Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Sunshine Coast Clinical School, Griffith University, Birtinya, Queensland, Australia. 6. Eastern Health Clinical School, Box Hill, Victoria, Australia. 7. Melbourne Brain Centre, University of Melbourne, Parkville, Victoria, Australia. 8. Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Stroke Foundation, Victoria, Australia. 9. Acute Stroke Services, John Hunter Hospital, Newcastle, New South Wales, Australia. 10. Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University. 11. The George Institute for Global Health and Faculty of Medicine, University of New South Wales, New South Wales, Australia. 12. Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia. 13. Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia. Electronic address: monique.kilkenny@monash.edu.
Abstract
BACKGROUND: Hospital arrival via ambulance influences treatment of acute stroke. We aimed to determine the factors associated with use of ambulance and access to evidence-based care among patients with stroke. METHODS: Patients with first-ever strokes from the Australian Stroke Clinical Registry (2010-2013) were linked with administrative data (emergency, hospital admissions). Multilevel, multivariable regression models were used to determine patient, clinical and system factors associated with arrival by ambulance. RESULTS: Among the 6,262 patients with first-ever stroke, 4,737 (76%) arrived by ambulance (52% male; 80% ischaemic). Patients who were older, frailer, with comorbidities or were unable to walk on admission (stroke severity) were more likely to arrive by ambulance to hospital. Compared to those using other means of transport, those who used ambulances arrived to hospital sooner after stroke onset (minutes, 124 vs 397) and were more likely to receive reperfusion therapy (adjusted odds ratio, 1.57, 95% CI: 1.09, 2.27). CONCLUSION: Patients with stroke who use ambulances arrived faster and were more likely to receive reperfusion therapy compared to those using personal transport. Further public education about using ambulance services at all times, instead of personal transport when stroke is suspected is needed to optimise access to time critical care.
BACKGROUND: Hospital arrival via ambulance influences treatment of acute stroke. We aimed to determine the factors associated with use of ambulance and access to evidence-based care among patients with stroke. METHODS:Patients with first-ever strokes from the Australian Stroke Clinical Registry (2010-2013) were linked with administrative data (emergency, hospital admissions). Multilevel, multivariable regression models were used to determine patient, clinical and system factors associated with arrival by ambulance. RESULTS: Among the 6,262 patients with first-ever stroke, 4,737 (76%) arrived by ambulance (52% male; 80% ischaemic). Patients who were older, frailer, with comorbidities or were unable to walk on admission (stroke severity) were more likely to arrive by ambulance to hospital. Compared to those using other means of transport, those who used ambulances arrived to hospital sooner after stroke onset (minutes, 124 vs 397) and were more likely to receive reperfusion therapy (adjusted odds ratio, 1.57, 95% CI: 1.09, 2.27). CONCLUSION:Patients with stroke who use ambulances arrived faster and were more likely to receive reperfusion therapy compared to those using personal transport. Further public education about using ambulance services at all times, instead of personal transport when stroke is suspected is needed to optimise access to time critical care.
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