Abstract WP235: Improved Paramedic Identification of Stroke: Utility of the Izumo Prehospital Apoplexy Scale and Prehospital Stroke Registry
Background and Purpose In Japan, rt-PA has been approved for use since 2005 for treating acute ischemic stroke within 3 hr of onset. Since emergency medical service (EMS) is often the first medical contact for stroke patients, EMS is an important step in stroke recovery. Recently, we developed the Izumo Prehospital Apoplexy Scale (IPAS) and started the prehospital stroke registry, including IPAS scores and information on diagnosis, therapy, and prognosis. We share this registry with EMS and exchange the data electronically; this helps providing regular feedback to EMS on accurate diagnosis, treatment, and prognosis of patients. The purpose of this study is to determine the effects of our feedback system on stroke care.
Methods We retrospectively reviewed the prehospital stroke registry to identify all patients evaluated using the IPAS and transported by EMS to our hospital between January 2010 and June 2011. We divided the patients into 2 groups: those evaluated between January 2010 and September 2010 (first period) and between October 2010 and June 2011 (second period). Sensitivity, specificity, and positive and negative predictive values of IPAS were determined. To assess the utility of IPAS on shortening of the duration from stroke onset to hospital arrival, we performed two comparisons; first, the comparison before and after IPAS introduction, second, the comparison between first and second period after IPAS introduction.
Results During the study period, 220 patients evaluated with IPAS were transported to our hospital. The sensitivity (0.86 versus 0.95, p = 0.03) and positive predict value (0.65 versus 0.78, p = 0.02) of the paramedic’s stroke/TIA identification significantly improved in the second period than in the first period. The duration from onset to arrival at the emergency department was significantly shorter in the second period (2.2 h versus 1.9 h, p = 0.04). Moreover, the duration was significantly shorter with IPAS use than without (3.8 h versus 2.2 h, p = 0.005).
Conclusions Sharing the prehospital stroke registry with EMS resulted in a 9% increase in sensitivity for identifying stroke patients in the prehospital setting. Moreover, feedback system contributed to shortening the duration from stroke onset to arrival at the emergency department.
- © 2012 by American Heart Association, Inc.