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Arrival by ambulance is associated with acute stroke intervention in young adults

https://doi.org/10.1016/j.jns.2012.02.004Get rights and content

Abstract

Background and purpose

Timely intervention in young stroke patients minimizes long term disability. We hypothesized that arrival to the emergency department by ambulance would be associated with increased rate of stroke intervention with intravenous t-PA or intra arterial procedures.

Methods

Charts of 77 patients aged 15–49 years diagnosed with ischemic stroke were analyzed. Data was collected on demographics, arrival to emergency department by ambulance, whether initial hospital at presentation was a Primary Stroke Center, and intervention by intravenous t-PA or intra arterial procedures. Data was analyzed by Fisher's exact test, and significant variables were included in multivariable analysis.

Results

Arrival by ambulance was significantly associated with acute stroke intervention in young adults (p = 0.016). Gender and Primary Stroke Center certification did not make a difference in patients getting stroke intervention.

Conclusion

Young adults with stroke symptoms were more likely to receive acute stroke intervention if they arrived by ambulance. Larger multi-center studies should address whether Primary Stroke Centers are more likely to provide either IV thrombolysis or interventional therapies in young patients with acute ischemic stroke.

Introduction

Ischemic stroke in young adults is less common, accounting for up to 12% of all ischemic strokes, and long-term mortality and functional deficits are less compared to the elderly [1]. However, on long-term follow-up, there remains a low level of health related quality of life in the domains of physical disability, depression and fatigue more pronounced in physical functioning [2]. Etiology of stroke also remains distinct in this population and timely intervention could minimize the long-term disability [3], [4].

Arrival by ambulance or self transportation to Emergency Department (ED) is one of the earliest factors in the chain of events for acute stroke care. Previous studies [5], [6], [7], [8] have shown pre-hospital triage and advanced notification by Emergency Medical Services (EMS), and organized stroke care between EMS and ED personnel decreased pre and in-hospital time delays and increased rates of thrombolysis. We hypothesized that arrival to ED by ambulance would be associated with an increase in acute stroke interventions with intravenous t-PA or intra arterial procedures in young adults with stroke.

Section snippets

Materials and methods

Patients aged 15–49 years evaluated between 2001 and 2010 at our University based outpatient Comprehensive Stroke Clinic and included in our Young Stroke Registry were analyzed for the study. Most patients were not admitted for their stroke events at our university-based hospital. Patients were seen at multiple hospitals in a metropolitan area of four millions residents for their acute ischemic stroke; and followed up with our clinic for outpatient care. Demographics, arrival to ED by ambulance,

Results

The baseline characteristics of the 77 patients analyzed for the study are listed in Table 1. The mean age ± SD of the patients was 37.9 ± 8.2 years. Twelve (15.8%) patients had acute stroke intervention – 7 intravenous tPA, 3 intra-arterial tPA and 2 mechanical thrombectomies.

The results of univariate analysis are presented in Table 2. The mean age, race and gender were not associated with getting stroke intervention. Patients who arrived by ambulance were more likely to get intervention compared

Discussion

Arrival by ambulance was associated with increased likelihood of getting stroke intervention in this young stroke cohort. This does not imply a causal relationship, however the finding of increased stroke intervention among patients who arrived by ambulance suggests that some mechanisms exists with the ambulance transportation leading to better thrombolysis rate. Coordinated stroke care between the EMS and ED personnel probably plays a major role in increasing stroke interventions by decreasing

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    Citation Excerpt :

    On the surface, it may seem that the utilization rate of t-PA in this sample is low. However, it should be noted that simple comparisons with the utilization rates in previous studies may not be appropriate as study samples can differ between analyses.6-8,16 In this study, we analyzed acute ischemic stroke patients, all of whom are potentially eligible for t-PA administration, although there may have been some patients who were contraindicated for this treatment.

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