Emergency Medical Services Prenotification is Associated with Reduced Odds of In-Hospital Mortality in Stroke Patients

Abstract

Objective

Arrival by emergency medical services (EMS) and prenotification among ischemic stroke patients are well-established to improve the timeliness and quality of stroke care, yet the association of prenotification with in-hospital mortality has not been previously described. Our cross-sectional study aimed to assess the association between EMS prenotification and in-hospital mortality for patients with acute ischemic stroke or transient ischemic attack.

Methods

We analyzed data from the Massachusetts Paul Coverdell National Acute Stroke Program registry. Our study population included adult patients presenting by EMS with transient ischemic attack or acute ischemic stroke from non-health care settings between 2016 and 2020. We excluded patients who were comfort measures only on arrival or day after arrival. We used generalized estimating equations to assess the association between prenotification and in-hospital stroke mortality.

Results

In the adjusted model, prenotification was associated with lower odds of in-hospital mortality (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.76–0.98). Other variables associated with in-hospital mortality were longer door-to-imaging interval (OR 1.03, 95% CI 1.03–1.04) and year of presentation (OR 0.91 for each year, 95% CI 0.88–0.93). Odds of in-hospital mortality also varied by insurance, race, and ethnicity.

Conclusions

Prenotification by EMS was associated with reduced in-hospital mortality for patients with ischemic stroke and transient ischemic attack. These findings add to the large body of literature demonstrating the key role of EMS in the stroke systems of care. Our study underscores the importance of standardizing prehospital screening and triage, increasing rates of prenotification via feedback and education, and encouraging active collaborations between prehospital personnel and stroke-capable hospitals to increase in-hospital survival among patients with stroke and transient ischemic attack.

Acknowledgments

We thank hospitals and emergency medical service agencies for participating in the Coverdell program. We thank Nora McElroy, MPH for providing information on Primary Stroke Service Hospitals and Ridgely Ficks, EMT for providing information on emergency medical services stroke care protocols. We thank Rebecca Cash, PhD, MPH for guidance on analysis of prehospital variables.

Disclosure Statement

The authors report that there are no competing interests to declare. The authors report no conflict of interest.

Additional information

Funding

This work was supported by Centers for Disease Control and Prevention (CDC).