Evidence map›Paper›PMID 24099829›Full record

ArticleEmergency medicine journal : EMJ2015

The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study.

James P Sheppard, Ruth M Mellor, Sheila Greenfield, Jonathan Mant, Tom Quinn, David Sandler, Don Sims, Satinder Singh, Matthew Ward, Richard J McManus and 1 more

Abstract read
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In one paragraph

Article in Emergency medicine journal : EMJ, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
21citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

21 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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  19. Effect of prehospital notification on acute stroke care: a multicenter study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2016
    Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

James P SheppardPrimary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Birmingham, West Midlands, UK Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, Oxfordshire, UK.
Ruth M MellorPrimary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Birmingham, West Midlands, UK.
Sheila GreenfieldPrimary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Birmingham, West Midlands, UK.
Jonathan MantPrimary Care Unit, University of Cambridge, Cambridge, Cambridgeshire, UK.
Tom QuinnFaculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey UK.
David SandlerHeart of England NHS Foundation Trust, Birmingham, West Midlands, UK.
Don SimsUniversity Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK.
Satinder SinghPrimary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Birmingham, West Midlands, UK.
Matthew WardWest Midlands Ambulance Service NHS Trust, Regional Ambulance Headquarters, Dudley, West Midlands, UK.
Richard J McManusDepartment of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, Oxfordshire, UK.
CLAHRC BBC investigators

Funding

Department of Health CDF/01/017Department of Health NIHR-RP-02-12-015Medical Research Council MR/K022032/1
6 · The paper itself

Abstract

backgroundHospital prealerting in acute stroke improves the timeliness of subsequent treatment, but little is known about the impact of prehospital assessments on in-hospital care.

objectiveExamine the association between prehospital assessments and notification by emergency medical service staff on the subsequent acute stroke care pathway.

methodsThis was a cohort study of linked patient medical records. Consenting patients with a diagnosis of stroke were recruited from two urban hospitals. Data from patient medical records were extracted and entered into a Cox regression analysis to investigate the association between time to CT request and recording of onset time, stroke recognition (using the Face Arm Speech Test (FAST)) and sending of a prealert message.

results151 patients (aged 71±15 years) travelled to hospital via ambulance and were eligible for this analysis. Time of symptom onset was recorded in 61 (40%) cases, the FAST test was positive in 114 (75%) and a prealert message was sent in 65 (44%). Following adjustment for confounding, patients who had time of onset recorded (HR 0.73, 95% CI 0.52 to 1.03), were FAST-positive (HR 0.54, 95% CI 0.37 to 0.80) or were prealerted (HR 0.26, 95% CI 0.18 to 0.38), were more likely to receive a timely CT request in hospital.

conclusionsThis study highlights the importance of hospital prealerting, accurate stroke recognition, and recording of onset time. Those not recognised with stroke in a prehospital setting appear to be excluded from the possibility of rapid treatment in hospital, even before they have been seen by a specialist.

Indexed as

AgedAged, 80 and overCohort StudiesEmergency Medical Service Communication SystemsEmergency Medical ServicesEmergency Service, HospitalFemaleHumansMaleMiddle AgedNeurologic ExaminationStrokeTime Factorsemergency ambulance systems, effectivenessepidemiologyimaging, CT/MRIparamedics, clinical managementstroke

Identifiers

PMID24099829
PMCPMC4316848

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.