Stroke Alert Notification By Emergency Department Or Emergency Medical Service Which One Shortened Door To Needle Time?

Background and Aim: Timely evaluation of patient with acute ischeamic stroke and administering tPA is the first step to ensure a good outcome. Emergency Medicine Service (EMS) prenotification and Emergency Department (ED) triage were two pathways to notify stroke team. However, which one faster is unclear. Method: We retrospectively reviewed the medical records of all patients who received IV tPA at our institution from 2007 to 2013. Clinical features at baseline and clinical quality measurements were recorded. Patients were classified into two groups, EMS prenotification group and ED triage group. Primary outcome was to compare the accuracy in stroke diagnosis between two groups. Secondary outcome was to explore the difference between the two processes on achieving clinical quality measurements. Result: During 2007 to 2013, stroke team was activated 1244 times by either EMS or ED for suspected stroke patient. Among them, 845 patients (70.3%) had a final diagnosis of stroke. More patients were ruled out of stroke in the ED group (34.2% vs 29.0%, p=0.039). After stroke team consultation, 288 patients receiving tPA. EMS prenotification significantly shorten the time of onset to treatment (OTT), door to needle (DTN) and OTST(onset to stroke team) in logistic regression analysis. Conclusion: EMS prenotification had less misdiagnosis of stroke than the stroke alert from ED. Moreover, EMS shortened the tPA treatment time significantly compared to ED notification. Our study confirmed that EMS was a more effective and accurate way to prenotify stroke team of patient with acute stroke than the ED.