Olascoaga Arrate A, Freijo Guerrero M M, Fernández Maiztegi C, Azkune Calle I, Silvariño Fernández R, Fernández Rodríguez M, Vazquez Naveira P, Anievas Elena A, Iturraspe González I, Pérez Díez Y, Ruiz Fernández R
Delegación Territorial de Bizkaia, Departamento de Salud del Gobierno Vasco, Bilbao, Bizkaia, España.
Servicio de Neurología, Hospital Universitario Basurto, Osakidetza, Bilbao, Bizkaia, España.
Neurologia (Engl Ed). 2019 Mar;34(2):80-88. doi: 10.1016/j.nrl.2016.11.004. Epub 2017 Jan 13.
According to numerous studies, using emergency medical services (EMS) to transport stroke patients to hospitals decreases diagnostic and treatment delays.
To determine the frequency of use of EMS by stroke patients in Bizkaia (Spain), analyse the factors associated with using EMS, and study the impact of EMS on time to care.
We gathered data from 545 patients hospitalised for acute ischaemic stroke and recruited consecutively. Data were obtained from the patients' medical histories and interviews with the patients themselves or their companions. We studied the following variables: previous health status, stroke symptoms and severity (NIHSS), type of transport, and time to medical care. Univariate and multivariate analyses were performed to identify factors associated with use of EMS and care delays.
Patients transported to hospital by the EMS accounted for 47.2% of the total. Greater stroke severity, arriving at the hospital at night, and poor functional status at baseline were found to be independently associated with use of EMS. Use of EMS was linked to earlier arrival at the hospital. Door-to-imaging times were shorter in the EMS group; however, this association disappeared after adjusting for stroke severity. Revascularisation was more frequent among patients transported by the EMS.
EMS transport was associated with shorter prehospital delays. Effective health education programmes should be developed to promote EMS transport for patients with stroke symptoms. In-hospital stroke management should also be improved to reduce time to medical care.
根据大量研究，使用紧急医疗服务（EMS）将中风患者转运至医院可减少诊断和治疗延误。
确定西班牙比斯开省中风患者使用EMS的频率，分析与使用EMS相关的因素，并研究EMS对就医时间的影响。
我们收集了545例因急性缺血性中风住院的患者的数据，这些患者是连续招募的。数据来自患者的病历以及对患者本人或其同伴的访谈。我们研究了以下变量：既往健康状况、中风症状和严重程度（美国国立卫生研究院卒中量表）、运输方式以及就医时间。进行单因素和多因素分析以确定与使用EMS和护理延误相关的因素。
通过EMS转运至医院的患者占总数的47.2%。发现中风严重程度更高、夜间到达医院以及基线时功能状态较差与使用EMS独立相关。使用EMS与更早到达医院有关。EMS组的门到影像检查时间更短；然而，在调整中风严重程度后，这种关联消失了。通过EMS转运的患者中血管再通更为频繁。
EMS转运与缩短院前延误相关。应制定有效的健康教育计划，以促进有中风症状的患者使用EMS转运。还应改善医院内的中风管理，以减少就医时间。
