Associations Between Prenotification and Time to Management in Acute Stroke Patients Transported by Emergency Medical Services.

Background: Acute stroke is a major health burden and prompt management at the emergency department (ED) is crucial for favorable outcomes.

Objectives: This study aimed to evaluate the associations between prehospital notification to the ED and time to management in acute ischemic stroke patients.

Methods: Patients with acute ischemic stroke who visited a thrombolysis-available ED through an emergency medical service (EMS) from July 2020 to December 2021 were included. The main exposure was prenotification by EMS personnel. The primary outcome was the time to management in acute stroke care metrics in ED-stroke critical pathway (CP) activation, brain radiographic evaluation, intravenous thrombolysis, mechanical thrombectomy, and stroke unit admission. Multivariable linear regression analysis was conducted.

Results: A total of 1107 acute ischemic stroke patients were included. The time to management was shorter in the prenotification group than in the control group; CP activation was 10 vs. 13.5 min, brain radiographic evaluation was 27 vs. 35 min, intravenous thrombolysis was 50.5 vs. 56.5 min, mechanical thrombectomy was 126.5 vs. 151.0 min, and stroke unit admission was 270.5 vs. 295.5 min. The prenotification group had a greater probability of a shorter time to management: Estimate (95% confidence intervals) was -15.7 min (-22.7 to -8.8) for CP activation, -13.8 min (-19.9 to -7.6) for brain radiographic evaluation, -20.9 min (-32.6 to -9.2) for intravenous thrombolysis, -81.6 min (-149.0 to -14.2) for mechanical thrombectomy, and -20.8 (-66.7 to -25.1) for stroke unit admission.

Conclusion: In acute ischemic stroke patients, prehospital prenotification was found to be associated with a shorter time to management.