An observational study of patient characteristics associated with the mode of admission to acute stroke services in North East, England.
OBJECTIVE:Effective provision of urgent stroke care relies upon admission to hospital by emergency ambulance and may involve pre-hospital redirection. The proportion and characteristics of patients who do not arrive by emergency ambulance and their impact on service efficiency is unclear. To assist...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3792886?pdf=render |
| _version_ | 1818175307265343488 |
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| author | Christopher I Price Victoria Rae Jay Duckett Ruth Wood Joanne Gray Peter McMeekin Helen Rodgers Karen Portas Gary A Ford |
| author_facet | Christopher I Price Victoria Rae Jay Duckett Ruth Wood Joanne Gray Peter McMeekin Helen Rodgers Karen Portas Gary A Ford |
| author_sort | Christopher I Price |
| collection | DOAJ |
| description | OBJECTIVE:Effective provision of urgent stroke care relies upon admission to hospital by emergency ambulance and may involve pre-hospital redirection. The proportion and characteristics of patients who do not arrive by emergency ambulance and their impact on service efficiency is unclear. To assist in the planning of regional stroke services we examined the volume, characteristics and prognosis of patients according to the mode of presentation to local services. STUDY DESIGN AND SETTING:A prospective regional database of consecutive acute stroke admissions was conducted in North East, England between 01/09/10-30/09/11. Case ascertainment and transport mode were checked against hospital coding and ambulance dispatch databases. RESULTS:Twelve acute stroke units contributed data for a mean of 10.7 months. 2792/3131 (89%) patients received a diagnosis of stroke within 24 hours of admission: 2002 arrivals by emergency ambulance; 538 by private transport or non-emergency ambulance; 252 unknown mode. Emergency ambulance patients were older (76 vs 69 years), more likely to be from institutional care (10% vs 1%) and experiencing total anterior circulation symptoms (27% vs 6%). Thrombolysis treatment was commoner following emergency admission (11% vs 4%). However patients attending without emergency ambulance had lower inpatient mortality (2% vs 18%), a lower rate of institutionalisation (1% vs 6%) and less need for daily carers (7% vs 16%). 149/155 (96%) of highly dependent patients were admitted by emergency ambulance, but none received thrombolysis. CONCLUSION:Presentations of new stroke without emergency ambulance involvement were not unusual but were associated with a better outcome due to younger age, milder neurological impairment and lower levels of pre-stroke dependency. Most patients with a high level of pre-stroke dependency arrived by emergency ambulance but did not receive thrombolysis. It is important to be aware of easily identifiable demographic groups that differ in their potential to gain from different service configurations. |
| first_indexed | 2024-12-11T19:58:13Z |
| format | Article |
| id | doaj.art-86e45b9140624bcfa40575a9913b4ee6 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-11T19:58:13Z |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-86e45b9140624bcfa40575a9913b4ee62022-12-22T00:52:36ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-01810e7699710.1371/journal.pone.0076997An observational study of patient characteristics associated with the mode of admission to acute stroke services in North East, England.Christopher I PriceVictoria RaeJay DuckettRuth WoodJoanne GrayPeter McMeekinHelen RodgersKaren PortasGary A FordOBJECTIVE:Effective provision of urgent stroke care relies upon admission to hospital by emergency ambulance and may involve pre-hospital redirection. The proportion and characteristics of patients who do not arrive by emergency ambulance and their impact on service efficiency is unclear. To assist in the planning of regional stroke services we examined the volume, characteristics and prognosis of patients according to the mode of presentation to local services. STUDY DESIGN AND SETTING:A prospective regional database of consecutive acute stroke admissions was conducted in North East, England between 01/09/10-30/09/11. Case ascertainment and transport mode were checked against hospital coding and ambulance dispatch databases. RESULTS:Twelve acute stroke units contributed data for a mean of 10.7 months. 2792/3131 (89%) patients received a diagnosis of stroke within 24 hours of admission: 2002 arrivals by emergency ambulance; 538 by private transport or non-emergency ambulance; 252 unknown mode. Emergency ambulance patients were older (76 vs 69 years), more likely to be from institutional care (10% vs 1%) and experiencing total anterior circulation symptoms (27% vs 6%). Thrombolysis treatment was commoner following emergency admission (11% vs 4%). However patients attending without emergency ambulance had lower inpatient mortality (2% vs 18%), a lower rate of institutionalisation (1% vs 6%) and less need for daily carers (7% vs 16%). 149/155 (96%) of highly dependent patients were admitted by emergency ambulance, but none received thrombolysis. CONCLUSION:Presentations of new stroke without emergency ambulance involvement were not unusual but were associated with a better outcome due to younger age, milder neurological impairment and lower levels of pre-stroke dependency. Most patients with a high level of pre-stroke dependency arrived by emergency ambulance but did not receive thrombolysis. It is important to be aware of easily identifiable demographic groups that differ in their potential to gain from different service configurations.http://europepmc.org/articles/PMC3792886?pdf=render |
| spellingShingle | Christopher I Price Victoria Rae Jay Duckett Ruth Wood Joanne Gray Peter McMeekin Helen Rodgers Karen Portas Gary A Ford An observational study of patient characteristics associated with the mode of admission to acute stroke services in North East, England. PLoS ONE |
| title | An observational study of patient characteristics associated with the mode of admission to acute stroke services in North East, England. |
| title_full | An observational study of patient characteristics associated with the mode of admission to acute stroke services in North East, England. |
| title_fullStr | An observational study of patient characteristics associated with the mode of admission to acute stroke services in North East, England. |
| title_full_unstemmed | An observational study of patient characteristics associated with the mode of admission to acute stroke services in North East, England. |
| title_short | An observational study of patient characteristics associated with the mode of admission to acute stroke services in North East, England. |
| title_sort | observational study of patient characteristics associated with the mode of admission to acute stroke services in north east england |
| url | http://europepmc.org/articles/PMC3792886?pdf=render |
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