EMS Systems Should Lower the Threshold for Stroke Alert Activation

THE RESEARCH Oostema JA, Konen J, Chassee T, et al. Clinical predictors of accurate prehospital stroke recognition. Stroke. 2015;46(6):1513–1517. THE SCIENCE Recognizing that prehospital stroke recognition and stroke code activation result in better outcomes for patients, the authors of the study examined all EMS records of suspected stroke transported over a 12-month period. They compared this to the patient’s final diagnosis. They also examined all patients diagnosed with stroke in the ED who weren’t recognized by EMS to be having a stroke. There were 441 eligible cases. Of those, 371 (84.1%) were “EMS-suspected” strokes and 70 (15.9%) were “EMS-missed” strokes. Of the EMS-suspected cases, 264 (59.9%) were confirmed as either an ischemic stroke or transient ischemic attack (TIA). All EMS cases were reviewed to determine if a Cincinnati Prehospital Stroke Scale (CPSS) was documented. When it was, EMS sensitivity to recognizing a patient with a stroke was 84.7%, but was only 30.9% when it wasn’t. Documenting a CPSS resulted in a positive predictive value of 56.2% compared to 30.4% without. The most common EMS impression for “EMS-missed” strokes was generalized weakness, altered mental status and dizziness. The most common final diagnoses for EMSsuspected strokes that weren’t strokes (false positives) were miscellaneous specific diagnosis (24.3%), nonspecific diagnosis (27.1%), infection (12.4%), seizure (11.3%) and syncope/ hypotension (10.2%). EMS-suspe...
Source: JEMS Special Topics - Category: Emergency Medicine Authors: Tags: Columns Patient Care Source Type: news