Evidence map›Paper›PMID 26949969›Full record

ArticleEmergency medicine journal : EMJ2016

Prevalence and predictors of hospital prealerting in acute stroke: a mixed methods study.

J P Sheppard, A Lindenmeyer, R M Mellor, S Greenfield, J Mant, T Quinn, A Rosser, D Sandler, D Sims, M Ward and 2 more

Open access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Emergency medicine journal : EMJ, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
0.7field-weighted citation impact, top 27% of its field
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

5 citing papers in PubMed, 13 citations in OpenAlex.

  1. 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

12 authors at 8 institutions in 1 country.

J P SheppardNuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, Oxfordshire, UK.
A LindenmeyerPrimary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Birmingham, West Midlands, UK.
R M MellorDepartment of Public Health, NHS Lanarkshire, Bothwell, UK.
S GreenfieldDepartment of Public Health, NHS Lanarkshire, Bothwell, UK.
J MantPrimary Care Unit, University of Cambridge, Cambridge, Cambridgeshire, UK.
T QuinnFaculty of Health, Social Care and Education, St George's, University of London & Kingston University, London, UK.
A RosserWest Midlands Ambulance Service NHS Trust, Regional Ambulance Headquarters, Dudley, West Midlands, UK.
D SandlerHeart of England NHS Foundation Trust, Birmingham, West Midlands, UK.
D SimsQueen Elizabeth Hospital Birmingham Elderly Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK.
M WardWest Midlands Ambulance Service NHS Trust, Regional Ambulance Headquarters, Dudley, West Midlands, UK.
R J McManusNuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, Oxfordshire, UK.
CLAHRC BBC investigators
East Midlands Ambulance Service NHS Trust · GBNHS Lanarkshire · GBUniversity of Oxford · GBHeart of England NHS Foundation Trust · GBQueen Elizabeth Hospital Birmingham · GBSt George's, University of London · GBUniversity of Birmingham · GBUniversity of Cambridge · GB

Funding

Department of Health CDF/01/017Department of Health NIHR-RP-02-12-015Department of Health WMCLAHRC-2014-1Medical Research Council MR/K022032/1
6 · The paper itself

Abstract

backgroundThrombolysis can significantly reduce the burden of stroke but the time window for safe and effective treatment is short. In patients travelling to hospital via ambulance, the sending of a 'prealert' message can significantly improve the timeliness of treatment.

objectiveExamine the prevalence of hospital prealerting, the extent to which prealert protocols are followed and what factors influence emergency medical services (EMS) staff's decision to send a prealert.

methodsCohort study of patients admitted to two acute stroke units in West Midlands (UK) hospitals using linked data from hospital and EMS records. A logistic regression model examined the association between prealert eligibility and whether a prealert message was sent. In semistructured interviews, EMS staff were asked about their experiences of patients with suspected stroke.

resultsOf the 539 patients eligible for this study, 271 (51%) were recruited. Of these, only 79 (29%) were eligible for prealerting according to criteria set out in local protocols but 143 (53%) were prealerted. Increasing number of Face, Arm, Speech Test symptoms (1 symptom, OR 6.14, 95% CI 2.06 to 18.30, p=0.001; 2 symptoms, OR 31.36, 95% CI 9.91 to 99.24, p<0.001; 3 symptoms, OR 75.84, 95% CI 24.68 to 233.03, p<0.001) and EMS contact within 5 h of symptom onset (OR 2.99, 95% CI 1.37 to 6.50 p=0.006) were key predictors of prealerting but eligibility for prealert as a whole was not (OR 1.92, 95% CI 0.85 to 4.34 p=0.12). In qualitative interviews, EMS staff displayed varying understanding of prealert protocols and described frustration when their interpretation of the prealert criteria was not shared by ED staff.

conclusionsUp to half of the patients presenting with suspected stroke in this study were prealerted by EMS staff, regardless of eligibility, resulting in disagreements with ED staff during handover. Aligning the expectations of EMS and ED staff, perhaps through simplified prealert protocols, could be considered to facilitate more appropriate use of hospital prealerting in acute stroke.

Indexed as

AgedEmergency Medical Service Communication SystemsEmergency Medical ServicesEnglandFemaleHumansInterviews as TopicMalePrevalenceRetrospective StudiesStrokeThrombolytic TherapyTime FactorsTransportation of PatientsTreatment Outcomeemergency departmentprehospital care

Identifiers

PMID26949969
PMCPMC4941194
OpenAlexW2295308162

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

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.