PT  - JOURNAL ARTICLE
AU  - Sheppard, James P
AU  - Mellor, Ruth M
AU  - Greenfield, Sheila
AU  - Mant, Jonathan
AU  - Quinn, Tom
AU  - Sandler, David
AU  - Sims, Don
AU  - Singh, Satinder
AU  - Ward, Matthew
AU  - McManus, Richard J
TI  - The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study
AID  - 10.1136/emermed-2013-203026
DP  - 2015 Feb 01
TA  - Emergency Medicine Journal
PG  - 93--99
VI  - 32
IP  - 2
4099  - http://emj.bmj.com/content/32/2/93.short
4100  - http://emj.bmj.com/content/32/2/93.full
SO  - Emerg Med J2015 Feb 01; 32
AB  - 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.