Abstract 173: Patterns and Predictors of Emergency Medical Services Pre-Notification of Potential Stroke Cases in the United States: Findings from GWTG-Stroke
Background: Emergency medical services (EMS) pre-notification of potential stroke arrivals has been recommended as a means of improving stroke evaluation and treatment times. However, little is known as to how frequently EMS pre-notification is being applied in the US, how use varies by hospital/state/region, and factors associated with EMS pre-notification.
Methods: Acute ischemic stroke patients transported by EMS to 1585 GWTG-Stroke hospitals from April 2003 to March 2011 were studied. Patient and hospital characteristics associated with EMS pre-notification were analyzed with multivariate GEE models.
Results: Of 371,988 acute ischemic stroke patients transported by EMS, pre-notification occurred in 249,197 (67.0%). Among hospitals with at least 10 EMS arriving stroke patients (n=1395), the median rate of pre-notification was 70.0 (25th-75th 34.0-92.9%, range 0%-100%). There was significant variation in pre-notification by state ranging from a low of 19.7% in Washington DC to a high of 93.4% in Montana. EMS pre-notification rates non-significantly increase over time, 58.0% in 2003 to 67.3% in 2011, p=0.10. Patient factors independently associated with EMS pre-notification include younger age, white race, no diabetes, and history of atrial fibrillation (Table). Hospital factors included region (West and Midwest), non-academic status, and higher annual IV tPA volumes (Table).
Conclusions: EMS pre-notification is provided in only two-thirds of EMS arriving GWTG-Stroke patients ultimately diagnosed with acute ischemic stroke in the US and varies substantially by hospital, state, and region in the US. Older patients, non-white, and those with certain comorbid conditions were significantly less likely to have EMS pre-notification. These findings suggest there are further opportunities to improve EMS pre-notification rates.
- © 2012 by American Heart Association, Inc.