Pre-Hospital Notification to Stroke Team Significantly Improves Acute Ischemic Stroke Outcome
Omair Ul Haq Lodhi1, Jeffrey Bowers2, Abhiram Parameswaran1, Joshua Vandeburgh3, Edward Labin1
1Neurology, University of Minnesota, 2University of California San Diego, 3University of Michigan
Objective:
This study aimed to evaluate whether pre-hospital notification by emergency medical service (EMS) providers to both the emergency department (ED) and stroke team improved intervention times and patient outcomes in cases of acute ischemic stroke (AIS).
Background:
Acute ischemic stroke treatment with intravenous thrombolysis (IVT) can improve clinical outcomes; however, efficacy is highly time-dependent. This study focuses on the impact of prehospital process improvement on clinical outcomes.
Design/Methods:
Data was retrospectively analyzed from a stroke registry from January 2022 through March 2024. The intervention, implemented in October 2022, involved EMS prehospital stroke code alerts being sent not only to the ED but also to the stroke team. Two groups were compared: one with prehospital notification only to the ED (before October 2022) and the other with notifications sent to both the ED and stroke team (after October 2022). Arrival-to-stroke code activation (SCA), stroke team arrival (STA), door-to-CT time (DTC), door-to-needle time (DTN), and 90-day modified Rankin Scale (mRS) outcomes were compared using T-Test. Patients were included in the analysis if they received IVT, arrived by EMS, and EMS had alerted the ED of potential stroke prior to arrival. Patients who arrived by triage or by EMS but without pre-hospital notification were excluded from analysis.
Results:
The analysis included 456 stroke cases. 234 occurred before and 222 after the implementation of the prehospital notification system. Results demonstrated that prehospital stroke team activation significantly reduced DTN from 33.67 to 27.16 minutes (p = 0.018), DTC from 10.23 to 8.57 minutes, and improved functional outcomes as measured by 90-day mRS, with scores improving from 1.81 to 1.27 (p = 0.045).
Conclusions:
Pre-hospital stroke code activation to the stroke team significantly reduced treatment times and improved patient outcomes. These findings support prehospital stroke code activation as a best practice in acute stroke care.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.