Ambulance Still First Choice for Stroke Transport

Patients with ischemic stroke should get to the emergency department (ED) by ambulance rather than private vehicle, according to a new study.

Researchers at Tulane University (New Orleans, LA, USA) followed 584 patients who were treated for acute ischemic stroke from January 2010 through November 2011; all patients were treated at the Tulane Medical Center ED. Included in the final analysis were 135 patients who were transported in an ambulance operated by New Orleans Emergency Medical Services (NOEMS), and 91 patients who arrived at the hospital in a private vehicle. The researchers conducted three separate analyses, adjusted for age, stroke severity, tissue plasminogen activator (tPA) status, and blood glucose at the time of admission.

In the first analysis, findings showed the method of transport was not an independent predictor of modified Rankin score 3-6 at discharge. After adjustments for baseline stroke severity, the mode of transportation was not a significant independent predictor of the length of stay in the hospital. They concluded that the use of a NOEMS ambulance did not increase the chances of a patient having poor outcome or prolonged length of stay in the hospital compared with private transportation. Patients that had Medicare benefits were more likely to use NOEMS than private vehicle transportation.

In the second analysis, the researchers noted that NOEMS patients were older, at an average of 66 years, than private vehicle delivered patients, which were an average of 64 years. NOEMS patients also had higher baseline glucose and Stroke Scale scores compared with private vehicle delivered patients, 119 versus 105 mg/dL, and 8 versus 3, respectively.

The third analysis considered arrival times, and in this case, NOEMS delivered patients were more likely to arrive at the hospital in 3 hours or less compared with private transport. NOEMS delivered patients also had higher odds of receiving tPA compared with private vehicle delivered patients, but the median door-to-needle time was insignificant between the groups, with 59 minutes for NOEMS versus 65 minutes for private vehicle. The study was presented as a poster session at the American Neurological Association (ANA) annual meeting, held during October 2013 in New Orleans (LA, USA).

“The severity of stroke symptoms and the length of time between the onset of symptoms and receiving treatment in a hospital were the greatest predictors of patient outcomes,” concluded lead author Sheryl Martin-Schild, MD, PhD, and colleagues. “At-home awareness of symptoms is really the key to lowering the time between onset of symptoms and treatment. Improving community awareness in the recognizing of symptoms is the best way to shorten the time to treatment.”

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Tulane University