Interactive Training of the Emergency Medical Services Improved Prehospital Stroke Recognition and Transport Time

Lukas Sveikata; Kazimieras Melaika; Adam Wiśniewski; Aleksandras Vilionskis; Kȩstutis Petrikonis; Edgaras Stankevičius; Kristaps Jurjans; Aleksandra Ekkert; Dalius Jatužis; Rytis Masiliūnas

doi:10.3389/fneur.2022.765165

Interactive Training of the Emergency Medical Services Improved Prehospital Stroke Recognition and Transport Time

Front Neurol. 2022 Apr 7:13:765165. doi: 10.3389/fneur.2022.765165. eCollection 2022.

Authors

Lukas Sveikata^{1

2}, Kazimieras Melaika³, Adam Wiśniewski⁴, Aleksandras Vilionskis^{5

6}, Kȩstutis Petrikonis⁷, Edgaras Stankevičius², Kristaps Jurjans^{8

9}, Aleksandra Ekkert¹⁰, Dalius Jatužis¹⁰, Rytis Masiliūnas¹⁰

Affiliations

¹ J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
² Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
³ Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
⁴ Department of Neurology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
⁵ Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.
⁶ Stroke Center, Republican Vilnius University Hospital, Vilnius, Lithuania.
⁷ Department of Neurology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
⁸ Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia.
⁹ Department of Neurology, Pauls Stradins Clinical University Hospital, Riga, Latvia.
¹⁰ Center of Neurology, Vilnius University, Vilnius, Lithuania.

Abstract

Background and purpose: Acute stroke treatment outcomes are predicated on reperfusion timeliness which can be improved by better prehospital stroke identification. We aimed to assess the effect of interactive emergency medical services (EMS) training on stroke recognition and prehospital care performance in a very high-risk cardiovascular risk population in Lithuania.

Methods: We conducted a single-center interrupted time-series study between March 1, 2019 and March 15, 2020. Two-hour small-group interactive stroke training sessions were organized for 166 paramedics serving our stroke network. We evaluated positive predictive value (PPV) and sensitivity for stroke including transient ischemic attack identification, onset-to-door time, and hospital-based outcomes during 6-months prior and 3.5 months after the training. The study outcomes were compared between EMS providers in urban and suburban areas.

Results: In total, 677 suspected stroke cases and 239 stroke chameleons (median age 75 years, 54.8% women) were transported by EMS. After the training, we observed improved PPV for stroke recognition (79.8% vs. 71.8%, p = 0.017) and a trend of decreased in-hospital mortality (7.8% vs. 12.3, p = 0.070). Multivariable logistic regression models adjusted for age, gender, EMS location, and stroke subtype showed an association between EMS stroke training and improved odds of stroke identification (adjusted odds ratio [aOR] 1.6 [1.1-2.3]) and onset-to-door ≤ 90 min (aOR 1.6 [1.1-2.5]). The improvement of PPV was observed in urban EMS (84.9% vs. 71.2%, p = 0.003), but not in the suburban group (75.0% vs. 72.6%, p = 0.621).

Conclusions: The interactive EMS training was associated with a robust improvement of stroke recognition, onset to hospital transport time, and a trend of decreased in-hospital mortality. Adapted training strategies may be needed for EMS providers in suburban areas. Future studies should evaluate the long-term effects of the EMS training and identify optimal retraining intervals.

Keywords: emergency medical services (EMS); prehospital/EMS; stroke; training; transient ischemic attack (TIA); triage.