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

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,...

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Autores principales: Xirasagar, Sudha, Tsai, Meng-han, Heidari, Khosrow, Hardin, James W., Wu, Yuqi, Wronski, Robert, Hurley, Dana, Jauch, Edward C., Sen, Souvik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892139/
https://www.ncbi.nlm.nih.gov/pubmed/31796059
http://dx.doi.org/10.1186/s12913-019-4741-6
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author Xirasagar, Sudha
Tsai, Meng-han
Heidari, Khosrow
Hardin, James W.
Wu, Yuqi
Wronski, Robert
Hurley, Dana
Jauch, Edward C.
Sen, Souvik
author_facet Xirasagar, Sudha
Tsai, Meng-han
Heidari, Khosrow
Hardin, James W.
Wu, Yuqi
Wronski, Robert
Hurley, Dana
Jauch, Edward C.
Sen, Souvik
author_sort Xirasagar, Sudha
collection PubMed
description 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.
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spelling pubmed-68921392019-12-11 Why acute ischemic stroke patients in the United States use or do not use emergency medical services transport? Findings of an inpatient survey Xirasagar, Sudha Tsai, Meng-han Heidari, Khosrow Hardin, James W. Wu, Yuqi Wronski, Robert Hurley, Dana Jauch, Edward C. Sen, Souvik BMC Health Serv Res Research Article 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. BioMed Central 2019-12-03 /pmc/articles/PMC6892139/ /pubmed/31796059 http://dx.doi.org/10.1186/s12913-019-4741-6 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Xirasagar, Sudha
Tsai, Meng-han
Heidari, Khosrow
Hardin, James W.
Wu, Yuqi
Wronski, Robert
Hurley, Dana
Jauch, Edward C.
Sen, Souvik
Why acute ischemic stroke patients in the United States use or do not use emergency medical services transport? Findings of an inpatient survey
title Why acute ischemic stroke patients in the United States use or do not use emergency medical services transport? Findings of an inpatient survey
title_full Why acute ischemic stroke patients in the United States use or do not use emergency medical services transport? Findings of an inpatient survey
title_fullStr Why acute ischemic stroke patients in the United States use or do not use emergency medical services transport? Findings of an inpatient survey
title_full_unstemmed Why acute ischemic stroke patients in the United States use or do not use emergency medical services transport? Findings of an inpatient survey
title_short Why acute ischemic stroke patients in the United States use or do not use emergency medical services transport? Findings of an inpatient survey
title_sort why acute ischemic stroke patients in the united states use or do not use emergency medical services transport? findings of an inpatient survey
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892139/
https://www.ncbi.nlm.nih.gov/pubmed/31796059
http://dx.doi.org/10.1186/s12913-019-4741-6
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