Evaluating Improvement in Acute Stroke Management following Pre-hospital Initiation of Acute Stroke Service
Prehospital Initiation of Stroke Care
Vol. 16 No. 1 : 2021 (69-75)
Abstract
Prehospital notification of the stroke team in alerting incoming acute stroke patient has been practiced in several countries worldwide. Currently this is not practiced in Malaysia. This study evaluates feasibility and impact to stroke team door to review time when prehospital notification is employed. Duration of case control study was between June 2018 to January 2019. Control phase consists of conventionally activating stroke team after in-hospital assessment by emergency medical officer. This was then followed by an intervention phase where on scene activation of stroke team was done by the Prehospital Emergency Care (PHC) staff. Training of PHC staff in recognising an acute stroke was based on identification of BE-FAST (Balance, Eyes, Face, Arm and Speech Test) abnormalities. The objectives were to compare the mean between two groups for acute stroke team review time, door to computerised tomography (CT) scan and door to thrombolysis time. Thirty-nine patients were analysed (control n=29, intervention n=10). Results were insignificant (p>0.05). Mean time in minutes for control phase vs. intervention phase was as follows: Door to stroke team review time, 25.96 + 39.16 vs. 15.9 + 13.14, door to CT scan was 43.04 + 40.00 vs. 25.8 + 11.35. Only 3 patients underwent thrombolytic therapy during study period. Limitation was non-parametric data with lack of number of acute stroke cases responded during the intervention period. With continual training of pre-hospital staff in detecting acute stroke, feasibility can be improved.
Keywords :
acute stroke,
Malaysia,
prehospital,
Correspondance Address
Nik Azlan Nik Muhamad. Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +6012-3956197 Email: nikazlanmuhamad@hotmail.com
References
Anuar, D.M.K., Nik Azlan, N.M., Mohd, A., Zuraidah, C.M. 2014. Stroke community awareness among public: a cross sectional study. Med & Health 9(1): 33-43.
Aroor, S., Singh, R., Goldstein, L.B. 2017. BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): reducing the proportion of strokes missed using the FAST mnemonic. Stroke 48(2): 479-81.
Bray, J.E., Martin, J., Cooper, G., Barger, B., Bernard, S., Bladin, C. 2005. An interventional study to improve paramedic diagnosis of stroke. Prehosp Emerg Care 9(3): 297-302.
Hashim, H., Hassan, R., Sharis, S., Azmin, S., Remli, R., Mukari, S.A., Yahya, N., Tan, H.J., Ibrahim, N.M., Ismail, M.S., Muda, S., Sahathevan, R. 2013. Evaluation of time-dependent pathways in an acute ischemic stroke protocol that incorporates CT perfusion: A tertiary referral centre experience. Neurol Asia 18(4): 355-60
Jauch, E.C., Saver, J.L., Adams, H.P., Bruno, A., Connors, J.J.B., Demaerschalk, B.M., Khatri, P. 2013. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 44(3): 870-947.
Nik, A.N.M., Muhamad, S.Z. 2019. Confidence level and knowledge of pre-hospital thrombolysis therapy of paramedic in prehospital care: a survey. Med & Health 14(1): 34-43.
Rajajee, V., Saver, J. 2005. Prehospital care of the acute stroke patient. Tech Vasc Interv Radiol 8(2): 74-80.
Shire, F., Kasim, Z., Alrukn, S., Khan, M. 2017. Stroke awareness among Dubai emergency medical service staff and impact of an educational intervention. BMC Res Notes 10(1): 255.
Zhang, S., Zhang, J., Zhang, M., Zhong, G., Chen, Z., Lin, L., Lou, M. 2018. Prehospital notification procedure improves stroke outcome by shortening onset to needle time in chinese urban area. Aging Dis 9(3): 426-34.
