Clinical Predictors of Accurate Prehospital Stroke Recognition

BACKGROUND AND PURPOSE—Prehospital activation of in-hospital stroke response hastens treatment but depends on accurate emergency medical services (EMS) stroke recognition. We sought to measure EMS stroke recognition accuracy and identify clinical factors associated with correct stroke identification...

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Bibliographic Details
Published in:Stroke (1970) 2015-06, Vol.46 (6), p.1513-1517
Main Authors: Oostema, J Adam, Konen, John, Chassee, Todd, Nasiri, Mojdeh, Reeves, Mathew J
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Brain Ischemia - diagnosis
Brain Ischemia - pathology
Brain Ischemia - physiopathology
Electronic Health Records
Emergency Medical Services - methods
Female
Humans
Male
Michigan
Middle Aged
Predictive Value of Tests
Registries
Severity of Illness Index
Stroke - diagnosis
Stroke - pathology
Stroke - physiopathology
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Summary:BACKGROUND AND PURPOSE—Prehospital activation of in-hospital stroke response hastens treatment but depends on accurate emergency medical services (EMS) stroke recognition. We sought to measure EMS stroke recognition accuracy and identify clinical factors associated with correct stroke identification. METHODS—Using EMS and hospital records, we assembled a cohort of EMS-transported suspect, confirmed, or missed ischemic stroke or transient ischemic attack cases. The sensitivity and positive predictive value (PPV) for EMS stroke recognition were calculated using the hospital discharge diagnosis as the gold standard. We used multivariable logistic regression analysis to determine the association between Cincinnati Prehospital Stroke Scale use and EMS stroke recognition. RESULTS—During a 12-month period, 441 EMS-transported patients were enrolled; of which, 371 (84.1%) were EMS-suspected strokes and 70 (15.9%) were EMS-missed strokes. Overall, 264 cases (59.9%) were confirmed as either ischemic stroke (n=186) or transient ischemic attack (n=78). The sensitivity of EMS stroke recognition was 73.5% (95% confidence interval, 67.7–78.7), and PPV was 52.3% (95% confidence interval, 47.1–57.5). Sensitivity (84.7% versus 30.9%; P
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.115.008650