Background: Emergency medical service stroke prenotification (EMS-SP) and stroke code activation improves stroke process measures for patients transported to the emergency department (ED) with stroke symptoms. We aimed to identify predictors of EMS-SP.
Methods: This retrospective analysis includes data collected from an ongoing quality improvement project at a University hospital for all adult stroke code activations for the last 4 months of 2024 and first month of 2025. Multivariable models were used to explore associations between patient demographics, clinical characteristics, and having EMS-SP versus not having EMS-SP.
Results: The mean age of the 149 patients in our sample was 67.2 (14.7) years, 85 (57%) were female, 107 (71.8%) were white, 23 (15.4%) were Hispanic, and 95 (63.8%) were determined to be mimics. There were no statistically significant differences in demographics for the 65 (43.6%) patients without EMS-SP versus the 84 (56.4%) patients with EMS-SP. Logistic model shows non-White race was associated with a higher odds of EMS-SP (OR, 2.44; 95%CI = 1.04-5.72); aphasia assessment being performed was associated with a higher odds of EMS-SP (OR, 6.89; 95%CI = 2.82-15.86); a nominally higher odds of EMS-SP was noted for every 5 year increase in age (OR, 1.11; 95%CI = 0.97-1.27); and a higher odds of EMS-SP was noted for every 10 mmHg increase in diastolic blood pressure (OR, 1.24; 95%CI = 1.02-1.47).
Conclusions: Patients with aphasia assessment done, who were older, not White, and had higher diastolic blood pressures were more likely to have EMS-SP. Pre-hospital stroke management, including education and feedback for emergency medical service, is warranted.
Keywords: Acute ischemic stroke; Emergency medical service; Stroke; Stroke mimics; Stroke prenotification.
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