Stroke Code Transports by Emergency Medical Services: Positive Predictive Value and Therapeutic Decisions in a Large Finnish Province

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Acta Neurologica Scandinavica Pub Date : 2026-02-06 DOI:10.1155/ane/9677875

Kristina Wikman, Tuukka Puolakka, Silja Räty, Markku Kuisma, Daniel Strbian

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Abstract

Background and Aims

Precise prehospital identification of cerebrovascular diseases (CVD) is essential for timely decisions concerning recanalization therapy for acute ischemic stroke (IS). This study described the stroke chain by analyzing patients transported by emergency medical services (EMS) with a stroke code, focusing on the EMS process regarding both CVD recognition and final recanalization decisions.

Methods

This retrospective, population-based, observational study analyzed all consecutive patients transported by EMS with suspected acute CVD in the Helsinki University Hospital service area during a 4-month period, irrespective of transport priority or receiving hospital. Prehospital and hospital patient records were combined, and the cohort was cross-checked with the database of given recanalization therapies. Sex-related and regional differences were assessed.

Results

Out of 1411 transports, 702 (50%) CVD diagnoses were identified. Of 521 high-priority transports, 317 (61%) received a CVD diagnosis and 98 (19%) recanalization therapy. Any recanalization therapy was given to 97/415 (23%) IS patients and to 91/211 (43%) IS patients transported with high priority. There were no significant sex-related or regional differences concerning diagnostic accuracy or treatment decisions. Altogether, 92% of the EMS transports ultimately leading to recanalization therapy were assigned high-priority stroke code.

Conclusions

The Finnish EMS system seems relatively accurate in identifying cerebrovascular disease; of all stroke-code transports, every second patient received a CVD diagnosis. Of the high-priority transports, 19% led to recanalization decisions. We observed no signs of gender or regional inequity. Most patients who received recanalization therapy were correctly identified by the EMS and transported with high priority, but this inevitably came at the expense of specificity.

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急诊医疗服务传递中风代码：芬兰一个大省的积极预测价值和治疗决策

背景与目的院前准确识别脑血管疾病（CVD）对急性缺血性脑卒中（is）再通治疗的及时决策至关重要。本研究通过分析带有卒中代码的紧急医疗服务（EMS）运送的患者来描述卒中链，重点关注EMS过程中心血管疾病识别和最终再通决策。方法：这项回顾性、基于人群的观察性研究分析了赫尔辛基大学医院服务区4个月内所有经EMS转运的疑似急性心血管疾病患者，不论转运优先顺序或接收医院。合并院前和住院患者记录，并与给予再通治疗的数据库交叉核对队列。评估了与性别相关的差异和地区差异。结果1411例转运者中，有702例（50%）被诊断为CVD。在521例高优先级转运中，317例（61%）接受了CVD诊断，98例（19%）接受了再通治疗。对97/415 (23%)IS患者和91/211（43%）优先转运的IS患者给予再通治疗。在诊断准确性或治疗决定方面，没有显著的性别或地区差异。总的来说，92%最终导致再通治疗的EMS转运被分配为高优先级卒中代码。结论芬兰EMS系统对脑血管疾病的诊断相对准确；在所有卒中编码转运中，每两名患者中就有一名被诊断为心血管疾病。在高优先级的传输中，19%导致了再通决策。我们没有观察到性别或地区不平等的迹象。大多数接受再通治疗的患者被EMS正确识别并优先转运，但这不可避免地以牺牲特异性为代价。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Neurologica Scandinavica 医学-临床神经学

CiteScore

6.70

自引率

2.90%

发文量

161

审稿时长

4-8 weeks

期刊介绍： Acta Neurologica Scandinavica aims to publish manuscripts of a high scientific quality representing original clinical, diagnostic or experimental work in neuroscience. The journal''s scope is to act as an international forum for the dissemination of information advancing the science or practice of this subject area. Papers in English will be welcomed, especially those which bring new knowledge and observations from the application of therapies or techniques in the combating of a broad spectrum of neurological disease and neurodegenerative disorders. Relevant articles on the basic neurosciences will be published where they extend present understanding of such disorders. Priority will be given to review of topical subjects. Papers requiring rapid publication because of their significance and timeliness will be included as ''Clinical commentaries'' not exceeding two printed pages, as will ''Clinical commentaries'' of sufficient general interest. Debate within the speciality is encouraged in the form of ''Letters to the editor''. All submitted manuscripts falling within the overall scope of the journal will be assessed by suitably qualified referees.