Prehospital Delay Factors After Stroke and Paramedic Identification of Stroke Patients in a Metropolitan City Emergency Medical Service System

BACKGROUND: Accurate recognition of stroke victims by ambulance paramedics is necessary to ensure the rapid transfer of these patients to the hospital. We carried out a prospective study to characterize the cause of prehospital delays after stroke by the emergency medical service (EMS) and to determine the accuracy of identifying acute stroke by paramedics. METHODS: All paramedics in the Busan Metropolitan 119 EMS were asked to record the clinical presentations and time intervals from symptom onset to various points along the patients' prehospital course on the ambulance admission sheets for suspected stroke patients during a month (February 1, 2010 to February 28, 2010). Neurologists in twenty four hospitals reviewed the hospital records for the patients who were given a diagnosis of stroke or transient ischemic attack by the paramedics. RESULTS: Of the EMS on-scene evaluations, the diagnosis of stroke by ambulance paramedics was correct for 79 of the 186 (43%) patients. Positive predictive values for main suspected stroke symptoms were 95% in hemiparesis, 88% in speech disturbance and 44% in impaired consciousness. The prehospital personnel transferred the suspected stroke patients to each hospital at a mean of 25 minutes after the emergency 119 call. However, only 62% of the stroke patients called EMS within the first 2 hours of stroke. CONCLUSIONS: Public education for the need to seek EMS promptly after stroke as a medical emergency, and strokespecific training for EMS personnel are essential so that stroke patients receive effective acute treatment.

The Difference in Aspirin Resistance Based on an Optical Platelet Aggregometer and the PFA-100 in Patients with Acute Ischemic Stroke / 대한뇌졸중학회지

BACKGROUND: There are many causes for the failure of aspirin therapy in patients with acute ischemic stroke. Laboratory aspirin resistance (AR) might be involved in clinical aspirin non-response. The PFA-100 is a laboratory method to evaluate AR in the clinical setting. However, there has been limited data regarding concordance with optical platelet aggregometry, which is considered the gold standard for detecting AR. We retrospectively analyzed platelet function tests using the PFA-100 and an optical platelet aggregometer in 86 patients with acute ischemic stroke. METHODS: Eighty six patients were enrolled in the study and were evaluated the platelet function test by optical aggregometer and a PFA-100. We determined the variability in the prevalence of AR and the kappa value between the two tests in patients with acute ischemic stroke. RESULTS: Among 86 patients, 27 (31.4%) were detected as AR by the optical aggregometer and 31 (36.0%) by the PFA-100. There were 13 cases of AR (15.1%) in both laboratory methods. The optical platelet aggregometer results showed that female gender (P=0.03), aspirin monotherapy (P =0.05), and NIHSS at baseline (P=0.04) were related with AR in acute ischemic stroke. Multiple logistic regression analysis showed that NIHSS was independently associated with AR of the optical platelet aggregometer (OR=1.12 95%, CI: 1.00-1.25, P=0.05). CONCLUSION: The prevalence of AR was similar between the PFA-100 and the optical platelet aggregometer in patients with acute ischemic stroke. However, the concordance rate of these two tools is low.