Advance hospital notification by EMS in acute stroke is associated with shorter door-to-computed tomography time and increased likelihood of administration of tissue-plasminogen activator

Abstract

Background: Rapid brain imaging is a critical step in facilitating the use of intravenous (IV) tissue-plasminogen activator (tPA) or catheter-based thrombolysis. We hypothesized that advance notification by emergency medical services (EMS) would shorten emergency department (ED) arrival-to-computed tomography (CT) time and increase the use of IV and intra-arterial thrombolysis, even at a tertiary care stroke center with high baseline rates of tPA use.

Methods: We analyzed data on all acute stroke patients transported from March 2004 to June 2005 by EMS from the scene to our facility arriving <or=6 hours from symptom onset. We reviewed digital voice recordings of all EMS communications to our hospital and in-hospital time intervals and outcomes from our stroke database.

Results: Among the 118 patients who met criteria, there were no significant differences between those with notification (n = 44) and those without (n = 74) in terms of age, gender, history of prior stroke, median National Institutes of Health Stroke Scale (NIHSS) score in the ED, proportion with mild stroke (NIHSS score <or=4), or mean onset-to-ED arrival time. Door-to-CT time was 17% shorter (40 vs. 47 minutes, p = 0.01) in the advance-notification group, and thrombolysis occurred twice as often (41% vs. 21%, p = 0.04).

Conclusion: Advance notification of patient arrival by EMS shortened time to CT and was associated with a modest increase in the use of thrombolysis at our hospital. This occurred even with protocols in place to shorten the time to CT for all acute stroke patients. Further research is needed to understand how to increase rates of advance notification by EMS in potential tPA candidates.