Recognition of visual symptoms in stroke: a challenge to patients, bystanders, and Emergency Medical Services.
Emergency Medical Services; stroke recognition
Prehospital
Stroke
Visual symptoms
Journal
BMC emergency medicine
ISSN: 1471-227X
Titre abrégé: BMC Emerg Med
Pays: England
ID NLM: 100968543
Informations de publication
Date de publication:
25 08 2023
25 08 2023
Historique:
received:
07
01
2023
accepted:
11
08
2023
medline:
28
8
2023
pubmed:
26
8
2023
entrez:
25
8
2023
Statut:
epublish
Résumé
Identification of visual symptoms as a sign of acute stroke can be challenging for both first line healthcare professionals and lay persons. Failed recognition of visual symptoms by medical dispatchers at the Emergency Medical Dispatch Center (EMDC-112) or personnel at the Out-of-Hours Health Service (OOHS) may delay stroke revascularization. We aimed to identify correct system response to visual symptoms in emergency calls. Phone calls from patient or bystander to the EMDC-112 or OOHS, which included visual symptoms on patients later verified with stroke/Transient ischemic attack (TIA) diagnosis, were analyzed. Data were stratified according to hospitalization within and after 4.5 h from symptom onset. Descriptive and multiple logistic regression analysis were performed. Of 517 calls identified, 290 calls fulfilled inclusion criteria. Only 30% of the patients received correct visitation by the medical dispatchers and referral to the hospital by a high-priority ambulance. Correct visitation was associated with early contact (adjusted OR: 2.37, 95% CI: 1.11, 5.03), contact to the EMDC-112 (adjusted OR: 3.18, 95% CI: 1.80, 5.62), and when the medical dispatcher asked additional questions on typical stroke symptoms (adjusted OR: 6.36, 95% CI: 3.01, 13.43). No specific visual symptom was associated with stroke recognition and fast hospitalization. First line healthcare professionals had significant problems in identifying visual symptoms as a sign of acute stroke and eliciting correct response. This highlights an urgent need to improve knowledge of visual symptoms in acute stroke and emphasize correct response to stroke symptoms in general.
Sections du résumé
BACKGROUND
Identification of visual symptoms as a sign of acute stroke can be challenging for both first line healthcare professionals and lay persons. Failed recognition of visual symptoms by medical dispatchers at the Emergency Medical Dispatch Center (EMDC-112) or personnel at the Out-of-Hours Health Service (OOHS) may delay stroke revascularization. We aimed to identify correct system response to visual symptoms in emergency calls.
METHODS
Phone calls from patient or bystander to the EMDC-112 or OOHS, which included visual symptoms on patients later verified with stroke/Transient ischemic attack (TIA) diagnosis, were analyzed. Data were stratified according to hospitalization within and after 4.5 h from symptom onset. Descriptive and multiple logistic regression analysis were performed.
RESULTS
Of 517 calls identified, 290 calls fulfilled inclusion criteria. Only 30% of the patients received correct visitation by the medical dispatchers and referral to the hospital by a high-priority ambulance. Correct visitation was associated with early contact (adjusted OR: 2.37, 95% CI: 1.11, 5.03), contact to the EMDC-112 (adjusted OR: 3.18, 95% CI: 1.80, 5.62), and when the medical dispatcher asked additional questions on typical stroke symptoms (adjusted OR: 6.36, 95% CI: 3.01, 13.43). No specific visual symptom was associated with stroke recognition and fast hospitalization.
CONCLUSIONS
First line healthcare professionals had significant problems in identifying visual symptoms as a sign of acute stroke and eliciting correct response. This highlights an urgent need to improve knowledge of visual symptoms in acute stroke and emphasize correct response to stroke symptoms in general.
Identifiants
pubmed: 37626329
doi: 10.1186/s12873-023-00870-2
pii: 10.1186/s12873-023-00870-2
pmc: PMC10463357
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
96Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Biochem Med (Zagreb). 2012;22(3):276-82
pubmed: 23092060
Neuroepidemiology. 2010;35(3):165-70
pubmed: 20571286
PLoS One. 2012;7(10):e46124
pubmed: 23056247
J Stroke Cerebrovasc Dis. 2013 Nov;22(8):e610-4
pubmed: 24075587
Community Eye Health. 2016;29(96):75-76
pubmed: 28381909
Nat Rev Neurol. 2009 Sep;5(9):477-83
pubmed: 19668246
Emerg Med J. 2013 Aug;30(8):669-74
pubmed: 22886891
J Biomed Inform. 2019 Jul;95:103208
pubmed: 31078660
Prehosp Emerg Care. 2005 Jan-Mar;9(1):19-23
pubmed: 16036823
Int J Stroke. 2013 Aug;8(6):408-12
pubmed: 22335960
Prehosp Emerg Care. 2018 Jul-Aug;22(4):466-471
pubmed: 29336708
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
Biomed Res Int. 2013;2013:719096
pubmed: 24089687
Brain Behav. 2017 Oct 06;7(11):e00771
pubmed: 29201538
J Am Heart Assoc. 2016 May 02;5(5):
pubmed: 27139735
Neuroepidemiology. 2006;26(3):168-75
pubmed: 16493205
Stroke. 2010 Jun;41(6):1108-14
pubmed: 20395614
Age Ageing. 2009 Mar;38(2):188-93
pubmed: 19029069
Circ Cardiovasc Qual Outcomes. 2013 May 1;6(3):262-9
pubmed: 23633218
Stroke Vasc Neurol. 2017 Jul 6;2(4):210-220
pubmed: 29507782
Scand J Trauma Resusc Emerg Med. 2019 Nov 4;27(1):100
pubmed: 31684982
Int J Emerg Med. 2022 Aug 25;15(1):40
pubmed: 36008756
Stroke. 2003 Apr;34(4):1005-9
pubmed: 12649511
BMJ Open. 2015 Apr 28;5(4):e007661
pubmed: 25922106
J Stroke Cerebrovasc Dis. 2011 Nov;20(6):494-502
pubmed: 20719538
J Neurol Neurosurg Psychiatry. 2000 Mar;68(3):277-88
pubmed: 10675208
Stroke. 2007 Feb;38(2):361-6
pubmed: 17204685
Brain Behav. 2021 Aug;11(8):e2225
pubmed: 34087953
Acta Neurol Scand. 2018 Jan;137(1):51-58
pubmed: 28804875
J Neurosci Nurs. 2015 Jun;47(3):154-9
pubmed: 25859748
Eur Stroke J. 2020 Dec;5(4):351-361
pubmed: 33598553
CMAJ. 2015 Sep 8;187(12):887-93
pubmed: 26243819
BMC Health Serv Res. 2019 Nov 7;19(1):813
pubmed: 31699103
Prehosp Emerg Care. 1999 Jul-Sep;3(3):211-6
pubmed: 10424858
Am J Emerg Med. 2010 Jun;28(5):607-12
pubmed: 20579558
Stroke. 2019 Dec;50(12):e344-e418
pubmed: 31662037
Tidsskr Nor Laegeforen. 2017 Jun 06;137(11):798-802
pubmed: 28597634