Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice

This fucking failure to identify strokes even with EMS personnel should initiate a crash program in finding an objective way to diagnose strokes. But we have NO leadership that will even attempt to make things better for stroke survivors. You are fucking screwed as long as we have NO stroke leadership and NO stroke strategy. What this means is YOU have to diagnose yourself and tell EMS about it. On your own again.
But are these other fast stroke diagnosis tools good enough to roll out to the world? Do you even know about them?

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds

 

Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds

 

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes

 Maybe these 17 diagnosis possibilities to find out which one is the best? Or maybe the Qualcomm Xprize for the tricorder?

Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice

Judy Jia¹, Roger Band², Michael E. Abboud^3,4, William Pajerowski⁵, Michelle Guo¹, Guy David^5,6, C. Crawford Mechem^7,8, Steven R. Messé¹, Brendan G. Carr² and Michael T. Mullen^1,6*

• ¹Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
• ²Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States
• ³Massachusetts General Hospital, Department of Emergency Medicine, Boston, MA, United States
• ⁴Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, MA, United States
• ⁵Department of Healthcare Management, Wharton School, University of Pennsylvania, Philadelphia, PA, United States
• ⁶Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
• ⁷Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
• ⁸Philadelphia Fire Department, Philadelphia, PA, United States

Background: Accurate recognition of stroke symptoms by Emergency Medical Services (EMS) is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city.

Methods and results: Philadelphia Fire Department data were merged with data from a single comprehensive stroke center to identify patients diagnosed with stroke or TIA from 9/2009 to 10/2012. Sensitivity and positive predictive value (PPV) were calculated. Multivariable logistic regression identified variables associated with correct EMS diagnosis. There were 709 total cases, with 400 having a discharge diagnosis of stroke or TIA. EMS crew sensitivity was 57.5% and PPV was 69.1%. EMS crew identified 80.2% of strokes with National Institutes of Health Stroke Scale (NIHSS) ≥5 and symptom duration <6 h. In a multivariable model, correct EMS crew diagnosis was positively associated with NIHSS (NIHSS 5–9, OR 2.62, 95% CI 1.41–4.89; NIHSS ≥10, OR 4.56, 95% CI 2.29–9.09) and weakness (OR 2.28, 95% CI 1.35–3.85), and negatively associated with symptom duration >270 min (OR 0.41, 95% CI 0.25–0.68). EMS dispatchers identified 90 stroke cases that the EMS crew missed. EMS dispatcher or crew identified stroke with sensitivity of 80% and PPV of 50.9%, and EMS dispatcher or crew identified 90.5% of patients with NIHSS ≥5 and symptom duration <6 h.

Conclusion: Prehospital diagnosis of stroke has limited sensitivity, resulting in a high proportion of missed stroke cases. Dispatchers identified many strokes that EMS crews did not. Incorporating EMS dispatcher impression into regional protocols may maximize the effectiveness of hospital destination selection and pre-notification.

Introduction

To be maximally effective, stroke therapies, including tissue plasminogen activator (rt-PA) and endovascular thrombectomy (ET), must be delivered as quickly as possible (1). The American Heart Association recommended development of regionalized systems of care, preferentially transporting patients to the nearest stroke center, rather than the nearest hospital (2, 3). These recommendations are being adopted across the US (4). The impetus to bring patients with severe stroke directly to a Comprehensive Stroke Center is particularly pressing given randomized trials showing benefit of endovascular therapy (1).

Regionalized systems of care are dependent on early and accurate identification of stroke patients by Emergency Medical Services (EMS). Although validated prehospital stroke scales exist, the diagnostic sensitivity of EMS varies from 44 to 72% in clinical practice (5–9). We aimed to determine prehospital diagnostic accuracy of EMS dispatchers and crews for stroke overall, for acute stroke patients with National Institutes of Health Stroke Scale (NIHSS) ≥5, and which clinical features were associated with correct prehospital identification of stroke.