Emergency Medicine: Open Access
Open Access

Abstract

Effects of Pre-Arrival Hospital Notification by Emergency Medicine Service System on Acute Stroke Patients: A New Experience in Kaohsiung City

Shih-Chiang Hung, Chia-Te Kung, Wen-Huei Lee, Hsien-Hung Cheng, Chia-Wei Liou, Mei-Hua Liang, Wan-Lan Tang, Yi-Jane Liu and Hung-Yi Chuang

Background: Acute ischemic stroke is a time-sensitive disease. Previous study has identified the most onset-tothrombolytic delay occurs in the prehospital phase. Pre-arrival hospital notification by EMS (emergency medicine system) could elimination some of the prehospital delay and has been recommended to increase the chance of administering thrombolytic therapy. Pre-arrival hospital notification by EMS is a new experience in Kaohsiung metropolitan, Taiwan. This study aimed to explore the effect of EMS pre-notification.
Methods: Stroke patients confirmed by hospital and suspected stroke patient pre-arrival notified by emergency medicine technicians (EMT) in the period of April to December 2013 were enrolled. Group comparisons were made between patients with and those without pre-notification using Student’s t-test, Chi-square test, and Fisher’s exact test. Logistic regression was performed to determine the association between variables with the early completion of brain CT.
Result: The study hospital received 1082 stroke patients in the study period, 237 (21.9%) of them were sent by EMS. 46 patients were sent to ED with pre-arrival hospital notification by EMT. The group with pre-arrival hospital notification had shorter door-to-CT and door-to-doctor times than the no pre-arrival notification group. However, there was no difference in the time lapse of door-to-drug. Factors of pre-arrival notification and hemorrhagic stroke were associated with early completion of brain CT in 10 minutes, with an OR of 6.3 (95% CI, 3.14-12.74) and 1.9 (95% CI, 1.00-3.59), respectively.
Conclusion: Pre-arrival hospital notification by EMS can shorten the elapsed time of door-to-CT and door-todoctor, but not of door-to-drug. Patients' hesitation may contribute the long lapse of CT-to-drug delivery. Simultaneous efforts to promote awareness of stroke in the community are recommended to shorten the time lapse of door-to-drug in synergy.