Article Text

The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study
  1. James P Sheppard1,2,
  2. Ruth M Mellor1,
  3. Sheila Greenfield1,
  4. Jonathan Mant3,
  5. Tom Quinn4,
  6. David Sandler5,
  7. Don Sims6,
  8. Satinder Singh1,
  9. Matthew Ward7,
  10. Richard J McManus2
  11. on behalf of the CLAHRC BBC investigators
  1. 1Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Birmingham, West Midlands, UK
  2. 2Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, Oxfordshire, UK
  3. 3Primary Care Unit, University of Cambridge, Cambridge, Cambridgeshire, UK
  4. 4Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey UK
  5. 5Heart of England NHS Foundation Trust, Birmingham, West Midlands, UK
  6. 6University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
  7. 7West Midlands Ambulance Service NHS Trust, Regional Ambulance Headquarters, Dudley, West Midlands, UK
  1. Correspondence to Professor Richard J McManus, Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, Oxfordshire OX2 6GG, UK; richard.mcmanus{at}


Background Hospital prealerting in acute stroke improves the timeliness of subsequent treatment, but little is known about the impact of prehospital assessments on in-hospital care.

Objective Examine the association between prehospital assessments and notification by emergency medical service staff on the subsequent acute stroke care pathway.

Methods This was a cohort study of linked patient medical records. Consenting patients with a diagnosis of stroke were recruited from two urban hospitals. Data from patient medical records were extracted and entered into a Cox regression analysis to investigate the association between time to CT request and recording of onset time, stroke recognition (using the Face Arm Speech Test (FAST)) and sending of a prealert message.

Results 151 patients (aged 71±15 years) travelled to hospital via ambulance and were eligible for this analysis. Time of symptom onset was recorded in 61 (40%) cases, the FAST test was positive in 114 (75%) and a prealert message was sent in 65 (44%). Following adjustment for confounding, patients who had time of onset recorded (HR 0.73, 95% CI 0.52 to 1.03), were FAST-positive (HR 0.54, 95% CI 0.37 to 0.80) or were prealerted (HR 0.26, 95% CI 0.18 to 0.38), were more likely to receive a timely CT request in hospital.

Conclusions This study highlights the importance of hospital prealerting, accurate stroke recognition, and recording of onset time. Those not recognised with stroke in a prehospital setting appear to be excluded from the possibility of rapid treatment in hospital, even before they have been seen by a specialist.

  • stroke
  • emergency ambulance systems, effectiveness
  • epidemiology
  • imaging, CT/MRI
  • paramedics, clinical management

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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