Emergency Service Hospital Prenotification Ups Stroke Tx

Prenotification improves timing of tPA administration, proportion of patients receiving tPA

TUESDAY, July 10 (HealthDay News) -- Emergency medical service (EMS) hospital prenotification results in more timely imaging and administration of tissue plasminogen activator (tPA) and an increased proportion of eligible patients with acute ischemic stroke receiving tPA, according to a study published online July 10 in Circulation: Cardiovascular Quality and Outcomes.

Cheryl B. Lin, from the Duke-National University of Singapore Graduate Medical School, and colleagues examined 371,988 patients with acute ischemic stroke who were transported by EMS and enrolled in Get With The Guidelines-Stroke from April 2003 through March 2011.

The researchers found that hospital prenotification occurred for 67.0 percent of EMS-transported patients. Patients with EMS prenotification who arrived within two hours were significantly more likely to be treated with tPA within three hours. Significantly shorter door-to-imaging times (26 versus 31 minutes), door-to-needle times (78 versus 80 minutes), and symptom onset-to-needle times (141 versus 145 minutes) were seen for those with EMS prenotification. Based on multivariate analysis that accounted for clustering of patients within hospitals, use of EMS prenotification was independently associated with increased likelihood of door-to-imaging times ≤25 minutes, door-to-needle times for tPA ≤60 minutes, onset-to-needle times ≤120 minutes, and tPA use within three hours.

"These findings support the need for initiatives targeted at improving EMS prenotification rates nationally as a mechanism for improving acute ischemic stroke quality of care and outcomes," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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