AUTHOR=Dylla Layne , Higgins Hannah M. , Wham Courtney D. , Leppert Michelle , Ravare Brandy C. , Jeppson Kerri A. , Bina Heather T. , Monte Andrew A. , Poisson Sharon N. 

TITLE=Identification of specific recommendations for prehospital stroke care associated with shorter door-to-CT times – An analysis of Get with the Guidelines-Stroke registry and prehospital data

JOURNAL=Frontiers in Stroke

VOLUME=Volume 3 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/stroke/articles/10.3389/fstro.2024.1355889

DOI=10.3389/fstro.2024.1355889

ISSN=2813-3056

ABSTRACT=Objective: Full compliance with American Heart Association (AHA) recommendations for prehospital care of stroke patients remains low. This study aims to identify components of prehospital care associated with shorter door-to-CT times.

Methods: Data from a comprehensive stroke center’s Get with the Guidelines-Stroke Registry was supplemented by prehospital medical records for ischemic stroke patients between January 1, 2018, and December 31, 2020. Descriptive statistics and multivariable linear regression modeling evaluated door-to-CT times for encounters compliant with AHA recommendations. 

Results:  There were 621 ischemic stroke patients who presented via a prehospital provider, 452 of whom presented from the scene. Without adjusting for potential confounders, shorter door-to-CT times were observed with EMS documentation of a last known well time, measurement of a blood glucose lever, prenotification of suspected stroke, or full compliance with AHA recommendations. Documentation of classic stroke signs, but not documentation of a prehospital stroke scale, was also observed to have shorter door-to-CT times compared to encounters where this did not occur.

Conclusions: During prehospital care of stroke, documentation of classic symptoms, obtaining a last known well time or time of symptom onset, obtaining a blood glucose level, prenotification of the receiving hospital of suspected stroke, and full guideline-compliance are associated with shorter door-to-CT times. Further studies are needed to understand if a shift in prehospital provider education, focusing on these key components of care, could lead to earlier diagnosis and treatment of acute stroke.