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| Ambulance arrival only modifiable predictor of speedy stroke admission |
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06 March 2006
Swiss researchers have found that stroke patients who are referred to hospital by the emergency services arrive there faster than other patients, as do those with strokes that occur in the carotid territory or that are particularly severe.
"Of these variables, all are non-modifiable except the referral pathway," say Dr Osei Agyeman and colleagues from the University of Bern. "Educational programs and stroke campaigns should therefore not only teach typical and less common stroke symptoms and signs, but also that emergency medical services provide the fastest means of transportation to the stroke unit and the best chances to get treatment early."
In agreement with previous studies, the team's analysis of the time to admission of 615 stroke patients found that they arrived faster when transported by the emergency medical services. After adjustment for travel time, ambulance arrivals were found to present an average of 189 minutes after symptom onset and helicopter arrivals took just 41 minutes, whereas those who were referred by other means took between 311 and 497 minutes from onset to hospital admission. On logistic regression analysis, patients with high National Institutes of Health Stroke Scale scores, indicating severe strokes, were significantly more likely to have a shorter time to admission than those with lower scores.
"Obviously, more severe symptoms in acute stroke are perceived more often as health- or life-threatening and prompt patients to seek immediate help," the authors write in the journal Stroke. Patients with strokes that occurred in the carotid territory reached hospital significantly faster than those whose strokes occurred in other cerebral regions. "A potential explanation is that carotid territory stroke signs are more obvious and more likely recognised as stroke both by laypersons as well as by doctors," the investigators suggest.
Reference:
Stroke 2006; 37 (4): 963-966.
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