Prehospital care process and hospital outcomes in stroke-code cases: comparison of basic and advance life support ambulance attendance
Silvia Solà Muñoz1, María del Mar Escudero Campillo1, Cristina Soro Borrega1, Youcef Azeli1, Soledad Querol Gil1, Antoni Ruiz1, Gemma Albacete1, Olga Moreno Peral1, Sergi Lluch1, Sergio Amaro Delgado2, Yolanda Silva Blas3, Xabier Urra2, Dolores Cocho Calderón4, Joan Martí Fàbregas5, Marc Ribó Jacobi6, Pere Cardona Portela7, Francisco Purroy García8, Esther Duarte Oller9, Verónica Hidalgo Benítez9, Alan Flores10, Marta Rubiera6, Ernest Palomeras11, Álvaro García-Tornel6, Rosa Suñer Soler12, Daniel Vilar Roquet13, Mercè Salvat-Plana14, Anna Ramos Pachón15, Natalia Pérez de la Ossa Herrero14, Xavier Jiménez Fàbrega1,14
Affiliation of the authors
1Sistema d’Emergències Mèdiques, Barcelona, Spain. 2Hospital Clínic, Barcelona, Spain. 3Hospital Doctor Josep Trueta, Girona, Spain. 4Hospital de Granollers, Barcelona, Spain. 5Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 6Hospital Vall d’Hebron, Barcelona, Spain. 7Hospital Universitari de Bellvitge, Barcelona, Spain. 8Hospital Arnau de Vilanova, Lleida, Spain. 9Hospital Parc de Salut Mar, Barcelona, Spain. 10Hospital Joan XXIII, Tarragona, Spain. 11Hospital de Mataró, Barcelona, Spain. 12Universitat de Girona. Grup de Recerca Salut i Atenció Sanitària, Girona, Spain. 13Pla Nacional d’Urgències de Catalunya (PLANUC), Servei Català de la Salut, Spain. 14Pla Director de la Malaltia Vascular Cerebral. Departament de Salut, Barcelona, Spain. 15Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
Solà Muñoz S, Escudero Campillo MM, Soro Borrega C, Azeli Y, Querol Gil S, Ruiz A, et al. Prehospital care process and hospital outcomes in stroke-code cases: comparison of basic and advance life support ambulance attendance. Emergencias. 2023;35:167-75
Summary
Objectives.
To study prehospital care process in relation to hospital outcomes in stroke-code cases first attended by 2 different levels of ambulance. To analyze factors associated with a satisfactory functional outcome at 3 months.
Methods.
Prospective multicenter observational cohort study. All stroke-code cases attended by prehospital emergency services from January 2016 to April 2022 were included. Prehospital and hospital variables were collected. The classificatory variable was type of ambulance attending (basic vs advanced life support). The main outcome variables were mortality and functional status after ischemic strokes in patients who underwent reperfusion treatment 90 days after the ischemic episode.
Results.
Out of 22 968 stroke-code activations, ischemic stroke was diagnosed in 12 467 patients (54.3%) whose functional status was good before the episode. Basic ambulances attended 93.1%; an advanced ambulance was ordered in 1.6% of the patients. Even though there were differences in patient and clinical characteristics recorded during the prehospital process, type of ambulance was not independently associated with mortality (adjusted odds ratio [aOR], 1.1; 95% CI, 0.77-1.59) or functional status at 3 months (aOR, 1.05; 95% CI, 0,72-1,47).
Conclusions.
The percentage of patient complications in stroke-code cases attended by basic ambulance teams is low. Type of ambulance responding was not associated with either mortality or functional outcome at 3 months in this study.
