Original ArticlePrehospital Stroke Identification: Factors Associated with Diagnostic Accuracy
Section snippets
Study Design
We performed a retrospective analysis to assess the performance of FDNY care providers in identifying stroke in the prehospital phase. Data used for this assessment were obtained from the FDNY prehospital care reports (ePCRs) and were compared against the local Get With The Guidelines (GWTG) database.19 The study was approved by the State University of New York Downstate Medical Center Institutional Review Board.
Study Setting
Brooklyn (Kings County) is the most populous of New York City's 5 boroughs and is
Results
Of the 72,984 adult patients (45% men, mean age = 47.6 ± 19.9 years) transported to the participating hospitals by FDNY EMS during the study period, 750 had strokes, of which 468 (true positives) were identified in the prehospital phase and 282 were missed (false negatives; Fig 1). Consult Table 1 for the distribution of stroke types. An additional 268 patients were misdiagnosed as having had strokes by EMS but later found to have alternate diagnoses (false positives). Table 1 summarizes the
Discussion
Our study overcomes limitations of previous studies by not relying on a prior suspicion of stroke, rather it considers how well strokes are identified in the entire population of ambulance-transported patients. Furthermore, factors affecting prehospital providers' impression of stroke have not been studied. This gap in our knowledge about prehospital stroke identification is addressed in the present study.
Delays in stroke diagnosis in the field may decrease the likelihood of receiving
Conclusions
FDNY EMTs and paramedics missed approximately one third of all stroke cases. We plan to use these findings to inform and improve our EMS educational methods. Better tools are needed for prehospital stroke screening, including development of more sensitive and specific prehospital stroke scales particularly targeted at identifying posterior circulation stroke syndromes. From our data, it seems prudent to activate in-hospital resources on EMS notification; individual hospitals must balance the
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The study was performed at the Departments of Emergency Medicine, Neurology, and the School of Public Health, State University of New York, Downstate Medical Center. Data were provided partially by the Fire Department of New York, Office of Medical Affairs.
This study was partially supported by NIH grants 1U01NS044364, R01 HL096944, 1U10NS077378, and 1U10NS080377.