Rates of emergency medical services (EMS) utilization for acute stroke remain low nationwide, despite the time-sensitive nature of the disease. Prior research suggests several demographic and social factors are associated with EMS use. We sought to evaluate which demographic or socioeconomic factors are associated with EMS utilization in our region, thereby informing future education efforts.
Methods:
We performed a retrospective analysis of patients for whom the stroke code system was activated at 2 hospitals in our region. Univariate and logistic regression analysis was performed to identify factors associated with use of EMS versus private vehicle.
Results:
EMS use was lower in patients who were younger, had higher income, were married, more educated and in those who identified as Hispanic. Those arriving by EMS had significantly faster arrival to code, arrival to imaging, and arrival to thrombolytic treatment times.
Conclusion:
Analysis of regional data can identify specific populations underutilizing EMS services for acute stroke symptoms. Factors effecting EMS utilization varies by region and this information may be useful for targeted education programs promoting EMS use for acute stroke symptoms. EMS use results in more rapid evaluation and treatment of stroke patients.
YangQTongXSchiebL, et al.Vital signs: recent trends in stroke death rates — United States, 2000–2015. MMWR Morb Mortal Wkly Rep. 2017;66(35):933–939.
2.
GlymourMMKoshelevaABoden-AlbalaB. Birth and adult residence in the Stroke Belt independently predict stroke mortality. Neurology. 2009;73(22):1858–1865.
3.
FonarowGCZhaoXSmithEE, et al.Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA. 2014;311(16):1632–1640.
4.
XianYSmithEEZhaoX, et al.Strategies used by hospitals to improve speed of tissue-type plasminogen activator treatment in acute ischemic stroke. Stroke2014;45(5):1387–1395.
5.
MaHCampbellBCVParsonsMW, et al.Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke. N Engl J Med. 2019;380(19):1795–1803.
6.
NogueiraRGJadhavAPHaussenDC, et al.Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11–21.
7.
AlbersGWMarksMPKempS, et al.Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708–718.
8.
LeesKRBluhmkiEvon KummerR, et al.Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, Atlantis, NINDS, and EPITHET trials. Lancet Lond Engl. 2010;375(9727):1695–1703.
9.
SaverJLGoyalMvan der LugtA, et al.Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: A meta-analysis. JAMA. 2016;316(12):1279–1288.
10.
PatelMDRoseKMO’BrienECRosamondWD. Prehospital notification by emergency medical services reduces delays in stroke evaluation: findings from the North Carolina Stroke care collaborative. Stroke. 2011; 42(8):2263–2268.
11.
LacyCRSuhDCBuenoMKostisJB. Delay in presentation and evaluation for acute stroke: Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.). Stroke. 2001;32(1):63–69.
12.
RosamondWDGortonRAHinnARHohenhausSMMorrisDL. Rapid response to stroke symptoms: the Delay in Accessing Stroke Healthcare (DASH) study. Acad Emerg Med. 1998;5(1):45–51.
13.
SchroederEBRosamondWDMorrisDLHinnAREvensonKR. Determinants of use of emergency medical services in a population with stroke symptoms: the Second Delay in Accessing Stroke Healthcare (DASH II) Study. Stroke. 2000;31(11):2591–2596.
14.
EkundayoOJSaverJLFonarowGC, et al.Patterns of emergency medical services use and its association with timely stroke treatment: findings from get with the guidelines-Stroke. Circ Cardiovasc Qual Outcomes. 2013;6(3):262–269.
15.
SaverJLSmithEEFonarowGC, et al.The ‘Golden Hour’ and acute brain ischemia: Presenting features and lytic therapy in >30 000 patients arriving within 60 minutes of stroke onset. Stroke. 2010;41(7):1431–1439.
16.
ShahSXianYShengS, et al.Use, temporal trends, and outcomes of endovascular therapy after interhospital transfer in the United States. Circulation. 2019;139(13):1568–1577.
17.
KamelHNaviBBFahimiJ. National trends in ambulance use by patients with stroke, 1997-2008. JAMA. 2012;307(10):1026–1028.
18.
Mochari-GreenbergerHXianYHellkampAS, et al.Racial/ethnic and sex differences in emergency medical services transport among hospitalized us stroke patients: analysis of the national get with the guidelines-stroke registry. J Am Heart Assoc. 2015;4(8):e002099.
19.
AddoJAyerbeLMohanKM, et al.Socioeconomic status and stroke: An updated review. Stroke. 2012;43(4):1186–1191.
20.
WilleyJZWilliamsOBoden-AlbalaB. Stroke literacy in central harlem: a high-risk stroke population. Neurology. 2009;73(23):1950–1956.
21.
HorvathMMWinfieldSEvansSSlopekSShangHFerrantiJ. The DEDUCE Guided Query tool: providing simplified access to clinical data for research and quality improvement. J Biomed Inform. 2011;44(2):266–276.
22.
BonitoABannCEicheldingerC, et al.Creation of new race-ethnicity codes and Socioeconomic Status (SES) Indicators for Medicare Beneficiaries: Final Report. Rockville, MD: Agency for Healchare Research and Quality, 2012.
23.
PowersWJRabinsteinAAAckersonT, et al.2018 Guidelines for the early management of patients with acute ischemic stroke: A Guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46–e110.
WeinTHStaubLFelbergR, et al.Activation of emergency medical services for acute stroke in a nonurban population: the T.L.L. Temple foundation stroke project. Stroke. 2000;31(8):1925–1928.
26.
AdeoyeOLindsellCBroderickJ, et al.Emergency medical services use by stroke patients: a population-based study. Am J Emerg Med. 2009;27(2):141–145.
27.
XirasagarSTsaiM-HHeidariK, et al.Why acute ischemic stroke patients in the United States use or do not use emergency medical services transport? Findings of an inpatient survey. BMC Health Serv Res. 2019;19(1):929.
28.
AlbertsMJPerryADawsonDVBertelsC. Effects of public and professional education on reducing the delay in presentation and referral of stroke patients. Stroke. 1992;23(2):352–356.
29.
MorgensternLBStaubLChanW, et al.Improving delivery of acute stroke therapy: The TLL Temple Foundation Stroke Project. Stroke. 2002;33(1):160–166.
30.
BettgerJPZhaoXBushnellC, et al.The association between socioeconomic status and disability after stroke: findings from the Adherence eValuation After Ischemic stroke Longitudinal (AVAIL) registry. BMC Public Health. 2014;14:281.
31.
KleindorferDLindsellCAlwellKA, et al.Patients living in impoverished areas have more severe ischemic strokes. Stroke. 2012;43(8):2055–2059.
32.
SeoMBegleyCLangabeerJRDelliFraineJL. Barriers and disparities in emergency medical services 911 calls for stroke symptoms in the United States adult population: 2009 BRFSS Survey. West J Emerg Med. 2014;15(2):251–259.
33.
MerinoJGLubyMBensonRT, et al.Predictors of acute stroke mimics in 8187 patients referred to a stroke service. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2013;22(8):e397–e403.
34.
HandPJKwanJLindleyRIDennisMSWardlawJM. Distinguishing between stroke and mimic at the bedside: the brain attack study. Stroke. 2006;37(3):769–775.
35.
BarsanWGBrottTGBroderickJPHaleyECLevyDEMarlerJR. Time of hospital presentation in patients with acute stroke. Arch Intern Med. 1993;153(22):2558–2561.
36.
MeurerWJLevineDAKerberKA, et al.Neighborhood influences on emergency medical services use for acute stroke: A population-based cross-sectional study. Ann Emerg Med. 2016;67(3):341–348.e4.
37.
HsiaAWCastleAWingJJ, et al.Understanding reasons for delay in seeking acute stroke care in an underserved urban population. Stroke. 2011;42(6):1697–1701.
38.
GlymourMMAvendañoMHaasSBerkmanLF. Lifecourse social conditions and racial disparities in incidence of first stroke. Ann Epidemiol. 2008;18(12):904–912.
39.
AzzimondiGBasseinLFioraniL, et al.Variables associated with hospital arrival time after stroke: effect of delay on the clinical efficiency of early treatment. Stroke. 1997;28(3):537–542.
