TY - JOUR
T1 - Why acute ischemic stroke patients in the United States use or do not use emergency medical services transport? Findings of an inpatient survey
AU - Xirasagar, Sudha
AU - Tsai, Meng Han
AU - Heidari, Khosrow
AU - Hardin, James W.
AU - Wu, Yuqi
AU - Wronski, Robert
AU - Hurley, Dana
AU - Jauch, Edward C.
AU - Sen, Souvik
N1 - Funding Information:
The study was supported by a grant to the University of South Carolina Research Foundation by F. Hoffmann-La Roche, Ltd. and Genentech, Inc. All funds were used towards personnel time-effort to complete the study, survey respondent gift cards, and towards travel to a professional conference to present the findings. Grant expenditures were managed through the University of South Carolina financial management system and approved in line with regulations governing ethical and responsible research expenditures. None of the authors were compensated directly by the funding agency. None of the authors have any conflict of interest.
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/12/3
Y1 - 2019/12/3
N2 - 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.
AB - 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.
KW - Acute ischemic stroke
KW - Ambulance use decisions
KW - Emergency medical services transport
KW - Factors affecting patients' EMS use decisions
KW - Knowledge about stroke
KW - Survey of stroke inpatients
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U2 - 10.1186/s12913-019-4741-6
DO - 10.1186/s12913-019-4741-6
M3 - Article
C2 - 31796059
AN - SCOPUS:85076041778
SN - 1472-6963
VL - 19
JO - BMC Health Services Research
JF - BMC Health Services Research
IS - 1
M1 - 929
ER -
