There were 799 cases that met the definition of possible stroke. Of these, 59.7% (n = 477) listed a primary impression of stroke, and the remaining cases (n = 322) were classified as possible stroke because they were dispatched as stroke but had no other diagnosis recorded. Most possible stroke cases (95.9%, n = 766) listed 9-1-1 as the response type. Others were identified as interfacility transfers or medical transports.
Sufficient information to calculate total response times (from 9-1-1 call to arrival at the ED) was available for only 132 of 799 possible stroke cases. The mean response time was 43.5 (SD 33.8) minutes. Information to calculate time from EMS notification to arrival on scene was available for 562 of 799 possible stroke cases; the mean time was 8.8 (SD 6.8) minutes. On-scene time (n = 561) averaged 14.3 minutes. Scene to ED was available for 652 and averaged 19.2 minutes.
Duration of onset (time from symptom onset until queried by EMS) was recorded for 344 of 799 possible stroke cases. Overall, the median duration of onset was 40 minutes. In urban areas, duration of onset was recorded for 57.8% (n = 199) of stroke cases with a median time of 30 minutes. In rural areas, 42.2% of stroke cases (n = 145) had a recorded median time of 45 minutes. The differences in duration of onset between rural and urban areas were not significant (P = .38).
There were 298 possible stroke cases that had sufficient data to calculate an estimate of symptom onset to ED arrival. Overall, 69.1% (206 of 298) had a symptom onset to ED arrival time of less than 120 minutes. In urban areas, 70.8% (119 of 168) of possible stroke cases had sufficient information recorded to calculate an onset-to-ED-door time of less than 120 minutes. In rural areas, 66.9% (87 of 130) had an onset-to-ED time of less than 120 minutes.
Determining the use and results of stroke scales proved problematic when the actual data were examined. Very few records indicated that the stroke scale had been performed. On review of the POLARIS data, we found that the stroke scale element was placed in the wrong section and was overlooked by EMTs filling out patient care reports because of its misplacement.
Of 799 possible stroke cases, 676 had a destination hospital identified. In urban areas, 64.3% (222 of 345) of patients with possible stroke cases were taken directly to 1 of the 4 Joint Commission-certified primary stroke centers in urban Utah. In rural areas, 16.6% (55 of 331) of patients with possible stroke cases were transported to hospitals with telestroke capability.
Of those cases that occurred in urban areas and whose record included a destination hospital, sufficient information was available for 91 cases to calculate total response times (from 9-1-1 call to arrival at the ED). Of these 91 cases, 54 were taken to a certified primary stroke center, and the mean total response time was 50.0 (SD 46.6) minutes. Thirty-seven of the 91 were taken to other urban hospitals with a mean total response time from 9-1-1 call to ED arrival of 33.8 (SD 11.5) minutes.