Prehospital Timecourse of Stroke Patients: Baseline Houston Experience
Background: Paramedic diagnostic accuracy in stroke and designation of stroke centers may improve treatment of acute stroke. We studied patients transported from the scene by paramedics with suspected acute stroke to 6 hospital candidate “ stroke center” sites in Houston as part of pre-intervention data collection for a study funded by the American Stroke Association aimed at increasing the number of patients that receive effective urgent stroke therapy. Methods: Candidate sites consisted of 2 university affiliated tertiary care and 4 community hospitals. Total time from suspected symptom onset to arrival in a study site emergency center, patient demographics, definitive diagnosis, and use of thrombolytic therapy were collected prospectively from September 1999 through March 2000. Results: The sample consisted of 446 patients with a paramedic diagnosis of acute stroke. Patient distribution to study sites was as follows: Hospital 1, n=153 (34.3%); Hospital 2, n=71 (15.9%); Hospital 3, n=72 (16.1%); Hospital 4, n=59 (13.2%); Hospital 5, n=64 (14.3%); Hospital 6, n=27 (6.1%). Average time from onset of symptoms suggestive of stroke to arrival in the emergency center was 226 minutes + 348 minutes (median 95 minutes; 234 patients (52%) arrived within 150 minutes of stroke symptom onset. Definitive stroke diagnosis was confirmed in 321 (72%) EMS transported cases; in 125 cases (28%) EMS misdiagnosed stroke for seizures, altered mental status, headache and syncope. Of valid stroke cases, 260 (81%) were ischemic and 61 (19%) were hemorrhagic. Total time from symptom onset to arrival in the emergency center was 196 ±240 minutes with a median of 90 minutes for ischemics, and 154 ±171 minutes with a median of 90 minutes for hemorrhages. Of this group, 216 (71%) of ischemic, and 43 (70%) hemorrhages arrived within 150 minutes of stroke symptom onset. A total of 21 (8%) patients received thrombolysis. Conclusions: Paramedic accuracy in diagnosing stroke is reasonable. Community and paramedic awareness of stroke and stroke-like symptoms in Houston already leads to over half of stroke patients arriving within the window for thrombolysis. An ongoing study will try to improve these statistics.