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Original Contribution

Accuracy of Emergency Medical Services–Reported Last Known Normal Times in Patients Suspected With Acute Stroke

David Curfman, Lisa Tabor Connor, Hawnwan Philip Moy, Laura Heitsch, Peter Panagos, Jin-Moo Lee, David K. Tan, Andria L. Ford
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https://doi.org/10.1161/STROKEAHA.113.003955
Stroke. 2014;45:1275-1279
Originally published March 18, 2014
David Curfman
From the Department of Neurology (D.C., P.P., J.-M.L., A.L.F.), Program in Occupational Therapy (L.T.C.), Department of Radiology (L.T.C., J.-M.L.), and Department of Emergency Medicine (H.P., L.H., P.P., D.K.T.), Washington University School of Medicine, MO.
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Lisa Tabor Connor
From the Department of Neurology (D.C., P.P., J.-M.L., A.L.F.), Program in Occupational Therapy (L.T.C.), Department of Radiology (L.T.C., J.-M.L.), and Department of Emergency Medicine (H.P., L.H., P.P., D.K.T.), Washington University School of Medicine, MO.
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Hawnwan Philip Moy
From the Department of Neurology (D.C., P.P., J.-M.L., A.L.F.), Program in Occupational Therapy (L.T.C.), Department of Radiology (L.T.C., J.-M.L.), and Department of Emergency Medicine (H.P., L.H., P.P., D.K.T.), Washington University School of Medicine, MO.
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Laura Heitsch
From the Department of Neurology (D.C., P.P., J.-M.L., A.L.F.), Program in Occupational Therapy (L.T.C.), Department of Radiology (L.T.C., J.-M.L.), and Department of Emergency Medicine (H.P., L.H., P.P., D.K.T.), Washington University School of Medicine, MO.
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Peter Panagos
From the Department of Neurology (D.C., P.P., J.-M.L., A.L.F.), Program in Occupational Therapy (L.T.C.), Department of Radiology (L.T.C., J.-M.L.), and Department of Emergency Medicine (H.P., L.H., P.P., D.K.T.), Washington University School of Medicine, MO.
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Jin-Moo Lee
From the Department of Neurology (D.C., P.P., J.-M.L., A.L.F.), Program in Occupational Therapy (L.T.C.), Department of Radiology (L.T.C., J.-M.L.), and Department of Emergency Medicine (H.P., L.H., P.P., D.K.T.), Washington University School of Medicine, MO.
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David K. Tan
From the Department of Neurology (D.C., P.P., J.-M.L., A.L.F.), Program in Occupational Therapy (L.T.C.), Department of Radiology (L.T.C., J.-M.L.), and Department of Emergency Medicine (H.P., L.H., P.P., D.K.T.), Washington University School of Medicine, MO.
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Andria L. Ford
From the Department of Neurology (D.C., P.P., J.-M.L., A.L.F.), Program in Occupational Therapy (L.T.C.), Department of Radiology (L.T.C., J.-M.L.), and Department of Emergency Medicine (H.P., L.H., P.P., D.K.T.), Washington University School of Medicine, MO.
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Abstract

Background and Purpose—The last known normal (LKN) time is a critical determinant of IV tissue-type plasminogen activator (IV tPA) eligibility; however, the accuracy of emergency medical services (EMS)-reported LKN times is unknown. We determined the congruence between neurologist-determined and EMS-reported LKN times and identified predictors of incongruent LKN times.

Methods—We prospectively collected EMS-reported LKN times for patients brought into the emergency department with suspected acute stroke and calculated the absolute difference between the neurologist-determined and EMS-reported LKN times (|ΔLKN|). We determined the rate of inappropriate IV tPA use if EMS-reported times had been used in place of neurologist-determined times. Univariate and multivariable linear regression assessed for any predictors of prolonged |ΔLKN|.

Results—Of 251 patients, mean and median |ΔLKN| were 28 and 0 minutes, respectively. |ΔLKN| was <15 minutes in 91% of the entire cohort and <15 minutes in 80% of patients with a diagnosis of stroke (n=86). Of patients who received IV tPA, none would have been incorrectly excluded from IV tPA if the EMS LKN time had been used. Conversely, of patients who did not receive IV tPA, 6% would have been incorrectly included for IV tPA consideration had the EMS time been used. In patients with wake-up stroke symptoms, EMS underestimated LKN times: mean neurologist LKN time−EMS LKN time =208 minutes. The presence of wake-up stroke symptoms (P<0.0001) and older age (P=0.019) were independent predictors of prolonged |ΔLKN|.

Conclusions—EMS-reported LKN times were largely congruent with neurologist-determined times. Focused EMS training regarding wake-up stroke symptoms may further improve accuracy.

  • Emergency Medical Services
  • last known normal time
  • stroke
  • Received October 25, 2013.
  • Accepted February 21, 2014.
  • © 2014 American Heart Association, Inc.
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    Accuracy of Emergency Medical Services–Reported Last Known Normal Times in Patients Suspected With Acute Stroke
    David Curfman, Lisa Tabor Connor, Hawnwan Philip Moy, Laura Heitsch, Peter Panagos, Jin-Moo Lee, David K. Tan and Andria L. Ford
    Stroke. 2014;45:1275-1279, originally published March 18, 2014
    https://doi.org/10.1161/STROKEAHA.113.003955

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    Accuracy of Emergency Medical Services–Reported Last Known Normal Times in Patients Suspected With Acute Stroke
    David Curfman, Lisa Tabor Connor, Hawnwan Philip Moy, Laura Heitsch, Peter Panagos, Jin-Moo Lee, David K. Tan and Andria L. Ford
    Stroke. 2014;45:1275-1279, originally published March 18, 2014
    https://doi.org/10.1161/STROKEAHA.113.003955
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