Why acute ischemic stroke patients in the United States use or do not use emergency medical services transport? Findings of an inpatient survey

Sudha Xirasagar, Meng Han Tsai, Khosrow Heidari, James W. Hardin, Yuqi Wu, Robert Wronski, Dana Hurley, Edward C. Jauch, Souvik Sen

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: Patients with acute ischemic stroke (AIS) who use emergency medical services (EMS) receive quicker reperfusion treatment which, in turn, mitigates post-stroke disability. However, nationally only 59% use EMS. We examined why AIS patients use or do not use EMS. Methods: During 2016-2018, a convenience sample of AIS patients admitted to a primary stroke center in South Carolina were surveyed during hospitalization if they were medically fit, available for survey when contacted, and consented to participate. The survey was programed into EpiInfo with skip patterns to minimize survey burden and self-administered on a touchscreen computer. Survey questions covered symptom characteristics, knowledge of stroke and EMS importance, subjective reactions, role of bystanders and financial factors. Descriptive and multiple regression analyses were performed. Results: Of 108 inpatients surveyed (out of 1179 AIS admissions), 49% were male, 44% African American, mean age 63.5 years, 59% mild strokes, 75 (69%) arrived by EMS, 33% were unaware of any stroke symptom prior to stroke, and 75% were unaware of the importance of EMS use for good outcome. Significant factors that influenced EMS use decisions (identified by regression analysis adjusting for stroke severity) were: prior familiarity with stroke (self or family/friend with stroke) adjusted odds ratio, 5.0 (95% confidence interval, 1.6, 15.1), perceiving symptoms as relevant for self and indicating possible stroke, 26.3 (7.6, 91.1), and bystander discouragement to call 911, 0.1 (0.01,0.7). Further, all 27 patients who knew the importance of EMS had used EMS. All patients whose physician office advised actions other than calling EMS at symptom onset, did not use EMS. Conclusion: Systematic stroke education of patients with stroke-relevant comorbidities and life-style risk factors, and public health educational programs may increase EMS use and mitigate post-stroke disability.

Original languageEnglish (US)
Article number929
JournalBMC Health Services Research
Issue number1
StatePublished - Dec 3 2019
Externally publishedYes


  • Acute ischemic stroke
  • Ambulance use decisions
  • Emergency medical services transport
  • Factors affecting patients' EMS use decisions
  • Knowledge about stroke
  • Survey of stroke inpatients

ASJC Scopus subject areas

  • Health Policy


Dive into the research topics of 'Why acute ischemic stroke patients in the United States use or do not use emergency medical services transport? Findings of an inpatient survey'. Together they form a unique fingerprint.

Cite this