Medical dispatchers recognise substantial amount of acute stroke during emergency calls.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101477511 Publication Model: Electronic Cited Medium: Internet ISSN: 1757-7241 (Electronic) Linking ISSN: 17577241 NLM ISO Abbreviation: Scand J Trauma Resusc Emerg Med Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central
    • Subject Terms:
      Registries*; Emergency Medical Service Communication Systems/*organization & administration ; Emergency Medical Services/*methods ; Stroke/*diagnosis ; Triage/*methods; Aged ; Aged, 80 and over ; Denmark/epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Stroke/epidemiology
    • Abstract:
      Background: Immediate recognition of stroke symptoms is crucial to ensure timely access to revascularisation therapy. Medical dispatchers ensure fast admission to stroke facilities by prioritising the appropriate medical response. Data on medical dispatchers' ability to recognise symptoms of acute stroke are therefore critical in organising emergency stroke care. We aimed to describe the sensitivity and positive predictive value of medical dispatchers' ability to recognise acute stroke during emergency calls, and to identify factors associated with recognition.
      Methods: This was an observational study of 2653 consecutive unselected patients with a final diagnosis of stroke or transient ischemic attack (TIA). All admitted through the Emergency Medical Services Copenhagen, during a 2-year study period (2012-2014). Final diagnoses were matched with dispatch codes from the Emergency Medical Dispatch Centre. Sensitivity and positive predictive value were calculated. The effect of age, gender, and time-of-day was analysed using multivariable logistic regression.
      Results: The sensitivity was 66.2 % (95 % CI: 64.4 %-68.0 %), and the positive predictive value was 30.2 % (95 % CI: 29.1 %-31.4 %). The multivariable logistic regression analyses showed that emergency calls during daytime and a final diagnosis of TIA vs. intracerebral haemorrhage (ICH), was positively associated with recognition of stroke (OR 2.70, 95 % CI: 2.04-3.57).
      Discussion: This study reports a high rate of stroke recognition compared to other studies ranging from 31% to 74%. The high sensitivity is likely the result of a profound reorganisation of the Emergency Medical ServicesCopenhagen, including the introduction of EMDs with a medical profession, and a criteria-based dispatch tool. A recognition rate of 100 % is not obtainable without an inappropriate amount of false positive cases.
      Conclusions: We report an overall high recognition of stroke by medical dispatchers. A final diagnosis of TIA, compared to ICH, was positively associated with recognition of acute stroke. Emergency medical dispatchers serve as the essential first step in ensuring fast-track stroke treatment, which would promote timely acute therapy.
      Trial Registration: Unique identifier: NCT02191514.
    • References:
      Clin Epidemiol. 2015 Nov 17;7:449-90. (PMID: 26604824)
      Stroke. 2012 Mar;43(3):776-81. (PMID: 22223240)
      Lancet Neurol. 2007 Dec;6(12):1063-72. (PMID: 17993293)
      Emerg Med J. 2009 Jun;26(6):442-5. (PMID: 19465622)
      Stroke. 2012 Jul;43(7):1912-7. (PMID: 22539544)
      J Vasc Interv Neurol. 2008 Jul;1(3):83-6. (PMID: 22518229)
      Stroke. 2007 Nov;38(11):3097-115. (PMID: 17901393)
      Prehosp Emerg Care. 1998 Oct-Dec;2(4):267-73. (PMID: 9799012)
      Scand J Public Health. 2011 Jul;39(7 Suppl):22-5. (PMID: 21775345)
      Prehosp Emerg Care. 2005 Jan-Mar;9(1):19-23. (PMID: 16036823)
      N Engl J Med. 2008 Sep 25;359(13):1317-29. (PMID: 18815396)
      Circulation. 2009 Apr 21;119(15):2023-5. (PMID: 19380632)
      Scand J Trauma Resusc Emerg Med. 2013 Jul 09;21:53. (PMID: 23835246)
      Cochrane Database Syst Rev. 2014 Jul 29;(7):CD000213. (PMID: 25072528)
      Prehosp Emerg Care. 2008 Jul-Sep;12(3):307-13. (PMID: 18584497)
      Scand J Trauma Resusc Emerg Med. 2014 Nov 13;22:65. (PMID: 25391354)
      Neurology. 2001 Apr 24;56(8):1015-20. (PMID: 11320171)
      Eur J Emerg Med. 2013 Feb;20(1):39-44. (PMID: 22343694)
      Lancet. 2014 Nov 29;384(9958):1929-35. (PMID: 25106063)
      JAMA. 2013 Jun 19;309(23):2480-8. (PMID: 23780461)
      Int J Qual Health Care. 2004 Apr;16 Suppl 1:i45-50. (PMID: 15059986)
      Stroke. 2003 Apr;34(4):1005-9. (PMID: 12649511)
      Circulation. 2009 Apr 21;119(15):2096-102. (PMID: 19349324)
      Neurology. 2005 Mar 8;64(5):817-20. (PMID: 15753415)
      Stroke. 2014 Oct;45(10):3070-2. (PMID: 25190440)
      Stroke. 2013 Mar;44(3):870-947. (PMID: 23370205)
      Stroke. 2009 Jun;40(6):2027-30. (PMID: 19390065)
      Circ Cardiovasc Qual Outcomes. 2012 Jul 1;5(4):514-22. (PMID: 22787065)
    • Contributed Indexing:
      Keywords: Emergency Medical Dispatch; Emergency Medical Services; Medical decision making; Stroke
    • Molecular Sequence:
      ClinicalTrials.gov NCT02191514
    • Publication Date:
      Date Created: 20160709 Date Completed: 20170117 Latest Revision: 20181113
    • Publication Date:
      20221213
    • Accession Number:
      PMC4936322
    • Accession Number:
      10.1186/s13049-016-0277-5
    • Accession Number:
      27388490