ArticleBMC emergency medicine2026
Decision to initiate transport to either Stroke Unit or local emergency department for patients with suspected stroke - a cohort study.
Article in BMC emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTimely access to specialized stroke treatment is critical for patient outcomes onset of stroke. In Region Zealand, Denmark, stroke care is centralized to a single Stroke Unit. However, it remains unclear whether distance to the Stroke Unit affects prehospital transport decisions and access to reperfusion therapy for these patients. The aim of this study was to examine whether distance to the Stroke Unit was associated with prehospital transport destination and access to reperfusion therapy among patients with suspected stroke.
methodWe conducted a retrospective cohort study of all Emergency Medical Services (EMS) dispatches for suspected stroke in Region Zealand from 2018 to 2022. The primary outcomes were transport destination (direct transport to the Stroke Unit versus local emergency department) and receipt of reperfusion treatment. Patients were categorized according to final diagnosis and transport destination: Stroke Unit or local emergency department. We examined stroke severity, time from symptom onset to EMS call, distance to Stroke Unit, and advanced treatment was administered. Descriptive characteristics were calculated for subgroups. Differences between groups were analysed using Fisher’s exact and Kruskal-Wallis tests.
resultsAmong 18,289 patients with stroke-suspected dispatches, 3,989 had a confirmed stroke diagnosis. Of these, 3,225 (81%) were transported to the Stroke Unit, while 764 (19%) were transported to a local hospital. Patients transported to the Stroke Unit had a median delay of 53 min from symptom onset to EMS call, compared to 2 h and 10 min for those transported elsewhere. Patients living more than 65 km from the Stroke Unit had a lower probability of direct transport and were less likely to receive reperfusion therapy for acute ischemic stroke, including intravenous thrombolysis and/or endovascular thrombectomy. (30.8% vs. 7.7%, p < 0.001).
conclusionGreater distance to Stroke Unit was associated with lower likelihood of direct transport and access to advanced treatment, despite similar stroke severity. This suggests a need for targeted interventions are needed to ensure equal access to stroke care for rural populations.
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