Background Stroke is a common time-sensitive medical emergency. Pre-hospital care focuses on rapid recognition and ambulance transportation. It is not unusual for stroke to be suspected amongst care home residents, who are typically older and have more complex health needs than the general population. The aim of this study was to describe the care of suspected stroke patients according to their residential status.

Methods Secondary analysis of an existing ambulance clinical record dataset from a UK ambulance service. It contained care parameters for patients labelled as suspected stroke by ambulance practitioners who had presented between December 2021 and April 2022. Patients were dichotomised based on private addresses or care home addresses. Patient characteristics and ambulance care were summarised according to residential status.

Results 1324 suspected stroke patients assessed at private addresses and 171 assessed at care homes. Care home patients were older (median 86 (IQR 79-91) years versus 75 (IQR 63-83) years; p= <0.001), had a greater number of comorbidities (median 5 (IQR 3-6) versus median 3 (IQR 2-5); p= <0.001) and more recorded medications (median 6 (IQR 4-9) versus median 4 (IQR 1-7); p= <0.001). Care home patients had higher rates of clinicians documenting that they were unable to record the Face Arm Speech Test (FAST) assessment (17/170 (10%) versus 39/1305 (3%); p= <0.001) but when assessment was possible, they were more likely to have a facial droop (85/153 (55.6%) versus 506/1266 (40%); p= <0.001). Ambulance on-scene time (OST) was 6-minutes longer in the care home group (median 41 (IQR 32- 49.5) minutes versus median 35 (IQR 27-45) minutes; p = <0.001).

Conclusions Suspected stroke patients assessed at care homes have more complex healthcare needs and differences in stroke assessment using the FAST. A longer OST was observed for care home residents which may reflect both the background health issues and stroke assessment challenges. Clinician awareness of differences between residential settings may be important for improving the delivery of emergency stroke care and further research is needed to optimize ambulance assessment for care home patients presenting with suspected stroke.