Houston paramedic and emergency stroke treatment and outcomes study (HoPSTO)

Anne Alexandrov, Andrei Alexandrov, Diana Rodriguez, David Persse, James C. Grotta

Research output: Contribution to journalArticle

164 Citations (Scopus)

Abstract

Background and Purpose - Establishment of stroke centers, combined with accurate paramedic diagnosis and rapid transport, is essential to deliver acute stroke therapy. We wanted to measure and improve paramedic and hospital performance through implementation of the Brain Attack Coalition and American Stroke Association guidelines. Methods - Pre-intervention and active-intervention phases with parallel data measurement points were used. The study involved six hospitals comprising the majority of acute-stroke admissions in Houston, Tex. Hospital, paramedic, and patient data were collected prospectively pre-intervention and during the active-intervention phase on all suspected acute-stroke patients admitted by Houston Fire Department-Emergency Medical Services. A multilevel educational intervention included paramedic, hospital, and community education. Paramedic diagnostic accuracy, hospital-performance efficiency, and thrombolytic treatment rates were the main outcome measures of the study. Results - Four hundred forty-six patients (74 per month) were transported in the pre-intervention phase to participating hospitals (59.8% of all suspected stroke patients transported city wide by Houston Fire Department-Emergency Medical Services), compared with 1072 patients (89 per month, or 68.7%) transported in the active-intervention phase (P<0.001). Accuracy of paramedic diagnosis of stroke increased from 61% to 79%. Admission within 2 hours of symptom onset increased from 58% to 62% (P=0.002). Thrombolysis rates increased in 4 of 6 centers, with 1 post-tissue plasminogen activator hemorrhage (3.7%) reported. Conclusions - A multilevel educational program improves rapid hospitalization and paramedic diagnostic accuracy and increases the number of patients presenting for evaluation within the 3-hour tissue plasminogen activator window. Stroke center development supports safe thrombolytic practice in community settings.

Original languageEnglish (US)
Pages (from-to)1512-1518
Number of pages7
JournalStroke
Volume36
Issue number7
DOIs
StatePublished - Jul 1 2005

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Allied Health Personnel
Emergency Treatment
Stroke
Outcome Assessment (Health Care)
Emergency Medical Services
Tissue Plasminogen Activator
Hospitalization
Guidelines
Hemorrhage
Education
Brain
Therapeutics

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Houston paramedic and emergency stroke treatment and outcomes study (HoPSTO). / Alexandrov, Anne; Alexandrov, Andrei; Rodriguez, Diana; Persse, David; Grotta, James C.

In: Stroke, Vol. 36, No. 7, 01.07.2005, p. 1512-1518.

Research output: Contribution to journalArticle

Alexandrov, Anne ; Alexandrov, Andrei ; Rodriguez, Diana ; Persse, David ; Grotta, James C. / Houston paramedic and emergency stroke treatment and outcomes study (HoPSTO). In: Stroke. 2005 ; Vol. 36, No. 7. pp. 1512-1518.
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