Analysis of Stroke Care Among 2019-2020 National Emergency Medical Services Information System Encounters

Layne Dylla; John D Rice; Sharon N Poisson; Andrew A Monte; Hannah M Higgins; Adit A Ginde; Paco S Herson

doi:10.1016/j.jstrokecerebrovasdis.2021.106278

Analysis of Stroke Care Among 2019-2020 National Emergency Medical Services Information System Encounters

J Stroke Cerebrovasc Dis. 2022 Mar;31(3):106278. doi: 10.1016/j.jstrokecerebrovasdis.2021.106278. Epub 2022 Jan 5.

Authors

Layne Dylla¹, John D Rice², Sharon N Poisson³, Andrew A Monte⁴, Hannah M Higgins⁵, Adit A Ginde⁶, Paco S Herson⁷

Affiliations

¹ Department of Emergency Medicine, University of Colorado School of Medicine, Aurora CO, USA. Electronic address: Layne.Dylla@cuanschutz.edu.
² Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora CO, USA. Electronic address: John.Rice@cuanschutz.edu.
³ Department of Neurology, University of Colorado School of Medicine, Aurora CO, USA. Electronic address: Sharon.Poisson@cuanschutz.edu.
⁴ Department of Emergency Medicine and Pharmaceutical Sciences, University of Colorado School of Medicine, Aurora CO, USA. Electronic address: Andrew.Monte@cuanschutz.edu.
⁵ Department of Emergency Medicine, University of Colorado School of Medicine, Aurora CO, USA. Electronic address: Hannah.Higgins@cuanschutz.edu.
⁶ Department of Emergency Medicine, University of Colorado School of Medicine. Electronic address: Adit.Ginde@cuanschutz.edu.
⁷ (7)Department of Neurological Surgery, The Ohio State University, Columbus OH, USA. Electronic address: Paco.Herson@osumc.edu.

PMID: 34998044
PMCID: PMC8851983
DOI: 10.1016/j.jstrokecerebrovasdis.2021.106278

Abstract

Objectives: Emergency Medicine Service (EMS) providers play a pivotal role in early identification and initiation of treatment for stroke. The objective of this study is to characterize nationwide EMS practices for suspected stroke and assess for gender-based differences in compliance with American Stroke Association (ASA) guidelines.

Materials and methods: Using the 2019-2020 National Emergency Medical Services Information System (NEMSIS) Datasets, we identified encounters with an EMS designated primary impression of stroke. We characterized patient characteristics and EMS practices and assessed compliance with eight metrics for "guideline-concordant" care. Multivariable logistic regression modeled the association between gender and the primary outcome (guideline-concordant care), adjusted for age, EMS level of service, EMS geographical region, region type (i.e. urban or rural), and year.

Results: Of 693,177 encounters with a primary impression of stroke, overall compliance with each performance metric ranged from 18% (providing supplemental oxygen when the pulse oximetry is less than 94%) to 76% (less than 90sec from incoming call to EMS dispatch). 2,382 (0.39%) encounters were fully guideline-concordant. Women were significantly less likely than men to receive guideline-concordant care (adjusted OR 0.82, 95% CI 0.75-0.89; 0.36% women, 0.43% men with guideline-concordant care).

Conclusions: A minority of patients received prehospital stroke care that was documented to be compliant with ASA guidelines. Women were less likely to receive fully guideline-compliant care compared to men, after controlling for confounders, although the difference was small and of uncertain climical importance. Further studies are needed to evaluate the underlying reasons for this disparity, its impact on patient outcomes, and to identify potential targeted interventions to improve prehospital stroke care.

Keywords: Acute ischemic stroke; Cerebrovascular infarction; Emergency medicine services; Stroke.

MeSH terms

Emergency Medical Dispatch
Emergency Medical Services*
Female
Guideline Adherence* / statistics & numerical data
Humans
Information Systems
Male
Practice Guidelines as Topic
Stroke* / diagnosis
Stroke* / therapy
United States

Abstract

MeSH terms

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