(Stroke. 2000;31:2591.)
© 2000 American Heart Association, Inc.
Original Contribution |
Determinants of Use of Emergency Medical Services in a Population With Stroke Symptoms
The Second Delay in Accessing Stroke Healthcare (DASH II) Study
From the Department of Epidemiology (E.B.S., W.D.R., K.R.E.), School of Public Health, and the Departments of Emergency Medicine (D.L.M.) and Neurology (A.H.), School of Medicine, University of North Carolina, Chapel Hill.
Background and Purpose—With the advent of time-dependent thrombolytic therapy for ischemic stroke, it has become increasingly important for stroke patients to arrive at the hospital quickly. This study investigates the association between the use of emergency medical services (EMS) and delay time among individuals with stroke symptoms and examines the predictors of EMS use.
Methods—The Second Delay in Accessing Stroke Healthcare Study (DASH II) was a prospective study of 617 individuals arriving at emergency departments in Denver, Colo, Chapel Hill, NC, and Greenville, SC, with stroke symptoms.
Results—EMS use was associated with decreased prehospital and in-hospital delay. Those who used EMS had a median prehospital delay time of 2.85 hours compared with 4.03 hours for those who did not use EMS (P=0.002). Older individuals were more likely to use EMS (odds ratio [OR] 1.21 for each 5-year increase, 95% CI 1.14 to 1.29), as were individuals who expressed a high sense of urgency about their symptoms (OR 1.69, 95% CI 1.09 to 2.62). Knowledge of stroke symptoms was not associated with increased EMS use (OR 0.63, 95% CI 0.40 to 0.98). Patients were more likely to use EMS if someone other than the patient first identified that there was a problem (OR 2.35, 95% CI 1.61 to 3.44).
Conclusions—Interventions aimed at increasing EMS use among stroke patients need to stress the urgency of stroke symptoms and the importance of calling 911 and need to be broad-based, encompassing not only those at high risk for stroke but also their friends and family.
Key Words: cerebrovascular disorders • emergency medical services • stroke onset • stroke, acute
This article has been cited by other articles:
 |
|
 |
|
  D. S Lasserson, A. Chandratheva, M. F Giles, D. Mant, and P. M Rothwell Influence of general practice opening hours on delay in seeking medical attention after transient ischaemic attack (TIA) and minor stroke: prospective population based study BMJ, September 18, 2008; 337(sep18_3): a1569 - a1569. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A Maestroni, C Mandelli, D Manganaro, B Zecca, P Rossi, V Monzani, and G Torgano Factors influencing delay in presentation for acute stroke in an emergency department in Milan, Italy Emerg. Med. J., June 1, 2008; 25(6): 340 - 345. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Mikulik, L. Bunt, D. Hrdlicka, L. Dusek, D. Vaclavik, and J. Kryza Calling 911 in Response to Stroke: A Nationwide Study Assessing Definitive Individual Behavior Stroke, June 1, 2008; 39(6): 1844 - 1849. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Mosley, M. Nicol, G. Donnan, I. Patrick, F. Kerr, and H. Dewey The Impact of Ambulance Practice on Acute Stroke Care Stroke, October 1, 2007; 38(10): 2765 - 2770. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Jarrell, A. Tadros, C. Whiteman, T. Crocco, and S. M. Davis National Healthline Responses to a Stroke Scenario: Implications for Early Intervention Stroke, August 1, 2007; 38(8): 2376 - 2378. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. W. Alexandrov Solving the Issue of Patient Arrival Time: A Call for Vigilant Action Stroke, August 1, 2007; 38(8): 2219 - 2220. [Full Text] [PDF]
|
|
|
|
 |
|
 H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Kobayashi, M. Skowronska, T. Litwin, and A. Czlonkowska Lack of experience of intravenous thrombolysis for acute ischaemic stroke does not influence the proportion of patients treated Emerg. Med. J., February 1, 2007; 24(2): 96 - 99. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. K. Moser, L. P. Kimble, M. J. Alberts, A. Alonzo, J. B. Croft, K. Dracup, K. R. Evenson, A. S. Go, M. M. Hand, R. U. Kothari, et al. Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke: A Scientific Statement From the American Heart Association Council on Cardiovascular Nursing and Stroke Council Circulation, July 11, 2006; 114(2): 168 - 182. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Place of Death After Stroke--United States, 1999-2002 JAMA, June 21, 2006; 295(23): 2717 - 2718. [Full Text] [PDF]
|
|
|
|
|
|
D. O. Kleindorfer, C. J. Lindsell, J. P. Broderick, M. L. Flaherty, D. Woo, I. Ewing, P. Schmit, C. Moomaw, K. Alwell, A. Pancioli, et al. Community Socioeconomic Status and Prehospital Times in Acute Stroke and Transient Ischemic Attack: Do Poorer Patients Have Longer Delays From 911 Call to the Emergency Department? Stroke, June 1, 2006; 37(6): 1508 - 1513. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Scott For Rich and Poor, the Message Is Still "Dial 9-1-1": But Is It Getting Through? Stroke, June 1, 2006; 37(6): 1354 - 1355. [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Z. Deng, M. J. Reeves, B. S. Jacobs, G. L. Birbeck, R. U. Kothari, S. L. Hickenbottom, A. J. Mullard, S. Wehner, K. Maddox, A. Majid, et al. IV tissue plasminogen activator use in acute stroke: Experience from a statewide registry Neurology, February 14, 2006; 66(3): 306 - 312. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Alberts, R. E. Latchaw, W. R. Selman, T. Shephard, M. N. Hadley, L. M. Brass, W. Koroshetz, J. R. Marler, J. Booss, R. D. Zorowitz, et al. Recommendations for Comprehensive Stroke Centers: A Consensus Statement From the Brain Attack Coalition Stroke, July 1, 2005; 36(7): 1597 - 1616. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Task Force Members, L. H. Schwamm, A. Pancioli, J. E. Acker III, L. B. Goldstein, R. D. Zorowitz, T. J. Shephard, P. Moyer, M. Gorman, S. C. Johnston, et al. Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems Stroke, March 1, 2005; 36(3): 690 - 703. [Full Text] [PDF]
|
|
|
|
|
|
L. H. Schwamm, A. Pancioli, J. E. Acker III, L. B. Goldstein, R. D. Zorowitz, T. J. Shephard, P. Moyer, M. Gorman, S. C. Johnston, P. W. Duncan, et al. Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems Circulation, March 1, 2005; 111(8): 1078 - 1091. [Full Text] [PDF]
|
|
|
|
|
|
California Acute Stroke Pilot Registry (CASPR) Inv Prioritizing interventions to improve rates of thrombolysis for ischemic stroke Neurology, February 22, 2005; 64(4): 654 - 659. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Kleindorfer, B. Kissela, A. Schneider, D. Woo, J. Khoury, R. Miller, K. Alwell, J. Gebel, J. Szaflarski, A. Pancioli, et al. Eligibility for Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke: A Population-Based Study Stroke, February 1, 2004; 35 (2): e27 - e29. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. E. Stahl, K. L. Furie, S. Gleason, and G. S. Gazelle Stroke: Effect of Implementing an Evaluation and Treatment Protocol Compliant with NINDS Recommendations Radiology, September 1, 2003; 228(3): 659 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Crocco, T. Gullett, S. M. Davis, N. Flores, L. Sauerbeck, E. Jauch, B. Threlkeld, B. Pio, M. Ottaway, A. Pancioli, et al. Feasibility of Neuroprotective Agent Administration by Prehospital Personnel in an Urban Setting Stroke, August 1, 2003; 34(8): 1918 - 1922. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. L. Katzan, T. W. Graber, A. J. Furlan, S. Sundararajan, C. A. Sila, G. Houser, and D. M. Landis Cuyahoga County Operation Stroke Speed of Emergency Department Evaluation and Compliance With National Institutes of Neurological Disorders and Stroke Time Targets Stroke, April 1, 2003; 34(4): 994 - 998. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Yoneda, T. Uehara, H. Yamasaki, Y. Kita, M. Tabuchi, and E. Mori Hospital-Based Study of the Care and Cost of Acute Ischemic Stroke in Japan Stroke, March 1, 2003; 34(3): 718 - 724. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. T. Schneider, A. M. Pancioli, J. C. Khoury, E. Rademacher, A. Tuchfarber, R. Miller, D. Woo, B. Kissela, and J. P. Broderick Trends in Community Knowledge of the Warning Signs and Risk Factors for Stroke JAMA, January 15, 2003; 289(3): 343 - 346. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Harraf, A. K Sharma, M. M Brown, K. R Lees, R. I Vass, and L. Kalra A multicentre observational study of presentation and early assessment of acute stroke BMJ, July 6, 2002; 325(7354): 17 - 17. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Morgenstern, L. Staub, W. Chan, T. H. Wein, L. K. Bartholomew, M. King, R. A. Felberg, W. S. Burgin, J. Groff, S. L. Hickenbottom, et al. Improving Delivery of Acute Stroke Therapy: The TLL Temple Foundation Stroke Project Stroke, January 1, 2002; 33(1): 160 - 166. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. R. Evenson, D. L. Morris, W. D. Rosamond, J. H. Brice, S. L. Huston, and E. M. Puckett Addressing Healthy People 2010 Objectives for Stroke Stroke, July 1, 2001; 32(7): 1692 - 1692. [Full Text] [PDF]
|
|
|
|
 |
|
 Education Still Needed on the Urgency of Stroke Care Journal Watch Neurology, February 21, 2001; 2001(221): 2 - 2. [Full Text]
|
|