Brown Aliza T, Wei Feifei, Culp William C, Brown Greg, Tyler Ryan, Balamurugan Appathurai, Bianchi Nicolas
Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205.
Department of Biostatistics, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205.
Am J Emerg Med. 2016 Aug;34(8):1640-4. doi: 10.1016/j.ajem.2016.06.044. Epub 2016 Jun 14.
Time delay is the key obstacle for receiving successful stroke treatment. Alteplase therapy must start within 4.5 hours from stroke occurrence. Rapid transport to a primary stroke center (PSC) or acute stroke-ready hospital (ASRH) by the emergency medical system (EMS) paramedics is vital. We determined transport time and destination data for EMS-identified and -delivered stroke suspects in Arkansas during 2013. Our objective was to analyze transport time and the hospital qualification for stroke care across the state.
The state's 75 counties were placed into 8 geographical regions (R1-R8). Transport time and hospital qualification were determined for all EMS-identified strokes. Each hospital's stroke care status was categorized as PSC, ASRH, a nonspecialty or unknown care facility (NSCF), out-of-state, or nonapplicable designation facilities.
There were 9588 EMS stroke ground transports with median within-region transport times of 29-40 minutes. Statewide, only 65% of EMS-transported stroke patients were transported to either PSC (12%) or ASRH (53%) facilities. One-third of the patients (30.6%) were delivered to NSCFs, where acute stroke therapy may rarely be performed. Regions with the highest suspected-stroke cases per capita also had the highest percentage of transports to NSCFs.
With only a few PSCs in Arkansas, EMS agencies should prioritize transporting stroke patients to ASRHs when PSCs are not regionally located.
时间延迟是成功进行中风治疗的关键障碍。阿替普酶治疗必须在中风发生后的4.5小时内开始。由紧急医疗系统（EMS）护理人员迅速转运至初级中风中心（PSC）或具备急性中风救治能力的医院（ASRH）至关重要。我们确定了2013年阿肯色州EMS识别并转运的中风疑似患者的转运时间和目的地数据。我们的目的是分析全州范围内的转运时间以及医院的中风护理资质。
该州的75个县被划分为8个地理区域（R1 - R8）。确定了所有EMS识别的中风患者的转运时间和医院资质。每家医院的中风护理状态被分类为PSC、ASRH、非专科或护理情况不明的机构（NSCF）、州外机构或指定不适用的机构。
共有9588例EMS地面转运的中风患者，区域内转运时间中位数为29 - 40分钟。在全州范围内，只有65%的经EMS转运的中风患者被转运至PSC（12%）或ASRH（53%）机构。三分之一的患者（30.6%）被送至NSCF机构，在这些机构中很少进行急性中风治疗。人均疑似中风病例数最高的区域，被转运至NSCF机构的比例也最高。
由于阿肯色州只有少数几个PSC，当区域内没有PSC时，EMS机构应优先将中风患者转运至ASRH。
