ABSTRACT
OBJECTIVE: Therapeutic options for ischaemic stroke, such as thrombolysis or thrombectomy, are time sensitive. Multiple innovations have been established to reduce the symptom-to-needle time. One such innovation is the prealerting of emergency department (ED) or stroke unit staff by prehospital personnel of suspected stroke patients. The diagnosis of stroke can sometimes be difficult, with stroke mimics being a recognized issue. The prealert mobilizes ED, stroke and imaging personnel, which, for a true-positive, improves door-to-needle times. However, there are a proportion of false-positive prealerts (nonstrokes) that have a significant resource activation implication. The aim of this study was to evaluate the positive predictive value of a prealert for stroke and transient ischaemic attack (TIA). METHODS: Ambulance service prealert forms for stroke and TIA collated by the ED were compared with the Scottish Stroke Audit database findings, ED electronic notes and imaging reports to establish whether the prealert was a true-positive or a false-positive. RESULTS: A prealert was obtained for 77 patients as query stroke/TIA. The true-positive rate was 52 and the false-positive rate was 25. The positive predictive value was 0.675. The median symptom-to-arrival time for prealerted patients was 97 min and the door-to-needle time for thrombolysis (n=17 patients) was 38 min. CONCLUSION: The diagnosis of true-positive stroke can be difficult in the prehospital environment. Although prealert has been shown to improve the patient's journey in terms of door-to-thrombolysis times, we have identified that the prealert has a significant false-positive rate that has important resource allocation and activation consequences. Further analysis of this may inform paramedic training and improve protocols for information handover.
Subject(s)
Emergency Medical Service Communication Systems/statistics & numerical data , Emergency Medical Services/organization & administration , Emergency Service, Hospital/organization & administration , Ischemic Attack, Transient/therapy , Outcome Assessment, Health Care , Stroke/therapy , Age Factors , Aged , Aged, 80 and over , Ambulances/statistics & numerical data , Emergency Responders , Female , Hospitalization/statistics & numerical data , Humans , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/mortality , Male , Middle Aged , Predictive Value of Tests , Risk Assessment , Scotland , Sex Factors , Stroke/diagnosis , Stroke/mortality , Tertiary Care Centers , Time-to-Treatment , Transportation of PatientsABSTRACT
The aim of this study was to describe the aetiology and severity of head injury in an infant (age<1 year) population presenting to a Scottish Paediatric Emergency Department (PED) and to discern preventable risk factors. The records of infants who presented to the PED of the Royal Aberdeen Children's Hospital between September 2010 and December 2011 with isolated head trauma were reviewed, patient demographics were extracted and information on aetiology, including nonaccidental injury (NAI), was recorded. Of 1574 attendances, 233 suffered isolated head injury. The majority (97%) were minor; six patients suffered skull fractures, three had traumatic intracranial haemorrhage and only three were considered to have sustained an NAI. The most common mode of injury was fall from a height (37%). Infants commonly present to the PED with head injury, many of which should be easily preventable. The number of cases because of NAI in our population is smaller than previously published figures.
