Frequency and accuracy of prehospital diagnosis of acute stroke

R. Kothari, W. Barsan, Thomas G Brott, J. Broderick, S. Ashbrock

Research output: Contribution to journalArticle

166 Citations (Scopus)

Abstract

Background and Purpose: This pilot study evaluated the frequency and accuracy of diagnosis of stroke made by prehospital care system dispatchers, emergency medical technicians (EMTs), and paramedics in one emergency medical services (EMS) system. In addition, the study determined patient prehospital triage and time intervals in the transport and evaluation of patients given a diagnosis of stroke by this EMS system. Methods: We reviewed records of 4413 consecutive prehospital records of a two-tiered EMS system for patients with potential stroke. Hospital records were obtained for patients given a diagnosis of stroke or transient ischemic attack (TIA) by an EMS dispatcher, EMT, or paramedic. The EMS system studied serves a community of 13 000 within the greater Cincinnati area. Results: Of 4413 EMS on-scene evaluations, the diagnosis of stroke or TIA was made by an EMT or paramedic for 96 patients (2%). Of the study population (n = 86), a final hospital discharge diagnosis of stroke or TIA was made for 62 patients (72%). EMS dispatchers correctly identified 52% and paramedics 72% of these 86 patients as having sustained a stroke or TIA. Twenty-two of the 86 patients required paramedic-level interventions, which included three intubations. Of the 24 patients whose symptoms were misdiagnosed as stroke or TIA by the paramedics, 16 (19%) had acute conditions for which effective therapies are available. Prehospital personnel arrived at the scene to examine potential stroke patients in a mean of 3 minutes after the emergency 911 call was received by the dispatcher. Patients transported by basic life support units (EMTs) arrived earlier at the hospital than did those transported by advanced life support units (paramedics) (40±1 versus 45±1 minutes, P=.004). However, patients transported by advanced life support units were seen by a physician sooner after arrival at the emergency department (10±2 versus 20±4 minutes, P=.02) and underwent computed tomography of the brain sooner (47±5 versus 69±10 minutes, P=.04). Conclusions: Prehospital evaluation of potential stroke patients can be accomplished promptly after the EMS system is activated. Urgent evaluation and transport of potential stroke patients is justified because paramedic-level interventions are frequently required and because almost 20% of patients with potential stroke have acute medical conditions for which effective specific therapies are available.

Original languageEnglish (US)
Pages (from-to)937-941
Number of pages5
JournalStroke
Volume26
Issue number6
StatePublished - 1995
Externally publishedYes

Fingerprint

Stroke
Allied Health Personnel
Emergency Medical Services
Emergency Medical Technicians
Transient Ischemic Attack
Hospital Records
Triage
Diagnostic Errors
Intubation
Hospital Emergency Service
Emergencies
Tomography
Physicians

Keywords

  • diagnosis
  • emergency medical services
  • stroke onset

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Kothari, R., Barsan, W., Brott, T. G., Broderick, J., & Ashbrock, S. (1995). Frequency and accuracy of prehospital diagnosis of acute stroke. Stroke, 26(6), 937-941.

Frequency and accuracy of prehospital diagnosis of acute stroke. / Kothari, R.; Barsan, W.; Brott, Thomas G; Broderick, J.; Ashbrock, S.

In: Stroke, Vol. 26, No. 6, 1995, p. 937-941.

Research output: Contribution to journalArticle

Kothari, R, Barsan, W, Brott, TG, Broderick, J & Ashbrock, S 1995, 'Frequency and accuracy of prehospital diagnosis of acute stroke', Stroke, vol. 26, no. 6, pp. 937-941.
Kothari R, Barsan W, Brott TG, Broderick J, Ashbrock S. Frequency and accuracy of prehospital diagnosis of acute stroke. Stroke. 1995;26(6):937-941.
Kothari, R. ; Barsan, W. ; Brott, Thomas G ; Broderick, J. ; Ashbrock, S. / Frequency and accuracy of prehospital diagnosis of acute stroke. In: Stroke. 1995 ; Vol. 26, No. 6. pp. 937-941.
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abstract = "Background and Purpose: This pilot study evaluated the frequency and accuracy of diagnosis of stroke made by prehospital care system dispatchers, emergency medical technicians (EMTs), and paramedics in one emergency medical services (EMS) system. In addition, the study determined patient prehospital triage and time intervals in the transport and evaluation of patients given a diagnosis of stroke by this EMS system. Methods: We reviewed records of 4413 consecutive prehospital records of a two-tiered EMS system for patients with potential stroke. Hospital records were obtained for patients given a diagnosis of stroke or transient ischemic attack (TIA) by an EMS dispatcher, EMT, or paramedic. The EMS system studied serves a community of 13 000 within the greater Cincinnati area. Results: Of 4413 EMS on-scene evaluations, the diagnosis of stroke or TIA was made by an EMT or paramedic for 96 patients (2{\%}). Of the study population (n = 86), a final hospital discharge diagnosis of stroke or TIA was made for 62 patients (72{\%}). EMS dispatchers correctly identified 52{\%} and paramedics 72{\%} of these 86 patients as having sustained a stroke or TIA. Twenty-two of the 86 patients required paramedic-level interventions, which included three intubations. Of the 24 patients whose symptoms were misdiagnosed as stroke or TIA by the paramedics, 16 (19{\%}) had acute conditions for which effective therapies are available. Prehospital personnel arrived at the scene to examine potential stroke patients in a mean of 3 minutes after the emergency 911 call was received by the dispatcher. Patients transported by basic life support units (EMTs) arrived earlier at the hospital than did those transported by advanced life support units (paramedics) (40±1 versus 45±1 minutes, P=.004). However, patients transported by advanced life support units were seen by a physician sooner after arrival at the emergency department (10±2 versus 20±4 minutes, P=.02) and underwent computed tomography of the brain sooner (47±5 versus 69±10 minutes, P=.04). Conclusions: Prehospital evaluation of potential stroke patients can be accomplished promptly after the EMS system is activated. Urgent evaluation and transport of potential stroke patients is justified because paramedic-level interventions are frequently required and because almost 20{\%} of patients with potential stroke have acute medical conditions for which effective specific therapies are available.",
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