The use of a pre-hospital questionnaire expedited the acute management of patients with ischemic stroke in a comprehensive stroke center

• Published in: Clinical neurology and neurosurgery 2024-09, Vol.244, p.108442, Article 108442
• Main Authors: Montalvan, V., Neves, G., Shannon, J., Clifford, T., Curry, J., Kahathuduwa, C., Tan, Y., Barnes, R., Kopel, J., Chintakayala, Laxmi, Brister, R., Hancock, S., Baugham, A., Hendley, K., Bhatt, N., Pollard, R.
• Format: Article
• Language: English
• Subjects: Acute stroke; Aged; Aged, 80 and over; Cohort Studies; Contraindications; Decision making; Emergency medical care; Emergency Medical Services; Emergency Medical Services - methods; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - therapeutic use; Humans; Ischemia; Ischemic Stroke - drug therapy; Ischemic Stroke - therapy; Male; Medical personnel; Middle Aged; Neurology; Patients; Stroke; Surveys and Questionnaires; Thrombolysis; Thrombolytic Therapy - methods; Time-to-Treatment; Variables
• ISSN: 0303-8467; 1872-6968; 1872-6968
• DOI: 10.1016/j.clineuro.2024.108442

Delays in intravenous thrombolysis (IVT) treatment for acute ischemic stroke decrease the benefit of treatment. Difficulties determining a patient's clinical eligibility for IVT is a frequent cause of treatment delays. We aimed to assess the effectiveness of the "PROVIDENCE" datasheet, a pre- hospital assessment of contraindications for IVT use applied by emergency medical services personnel. We performed a single-center cohort study comparing IVT decision and treatment times between patients with PROVIDENCE datasheets and those without. Patients were eligible if they were over 18 years old and presented to our comprehensive stroke center from the field with stroke-like symptoms with onset within 4.5 hours. We identified 465 records and included 166 records in our final analysis (54 in the study group and 112 in the control group). A subgroup of 85 patients received IVT (30 in the study group patients and 55 in the control group). The PROVIDENCE datasheet was associated with a faster median time by five minutes from the patient's initial presentation at the emergency department to the final decision regarding IVT eligibility (p = 0.032) and a faster time between the first encounter with a neurology provider and the decision regarding IVT administration by six minutes (p = 0.002) for the entire sample. In the subgroup that received IVT, the PROVIDENCE datasheet decreased the median decision time by seven minutes (p = 0.044) There was no significant difference in door-to-needle times between groups. Using the PROVIDENCE datasheet, first responders can quickly identify potential contraindications for IVT treatment in patients with stroke-like symptoms. This tool expedited decision-making and led to faster IVT administration process at a comprehensive stroke center. •Confirming a patient's eligibility for intravenous thrombolysis is a frequent cause of treatment delays.•We tested the a pre- hospital assessment of contraindications for IV thrombolysis used by EMS.•Using the PROVIDENCE datasheet expedited decision-making in acute stroke.•Although not significant, PROVIDENCE datasheet group had shorter door-needle times.