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22-02-2012 | Cardiology | Article

Common stroke symptoms rarely reported in emergency calls


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MedWire News: People who call the emergency medical services (EMS) about a suspected stroke rarely mention any of the common stroke symptoms, a large analysis shows.

Callers tended to report the consequences of stroke symptoms, such as collapse or inability to grip, rather than the symptoms themselves.

"This has important implications for training EMDs [emergency medical dispatchers] to recognise patients with possible stroke," say Stephanie Jones (University of Central Lancashire, Preston, UK) and colleagues from the ESCORTT group.

The team analyzed 592 calls made to the EMS in north-west England by or on behalf of a patient who had stroke suspected at some point in the subsequent care pathway. Most (55%) calls were made by family members, followed by nursing home staff (13%), and most (67%) callers were women.

Just 5% of callers mentioned symptoms from the Face Arm Speech Test (FAST), with speech symptoms most commonly mentioned, at 2%. No caller mentioned all three symptoms, despite 27% of patients having all three FAST symptoms later recorded in their medical records. However, the researchers note that the study period, from October 2006 to September 2007, preceded a campaign to publicize FAST.

The first problem mentioned by callers was most often fall or collapse, at 26%, but stroke was also frequently mentioned, at 25%. In all, 89% of callers who thought the patient was having a stroke were proved correct.

The EMDs used a stroke dispatch code for 45% of patients, 83% of whom had a final diagnosis of stroke. However, just 37% of these patients were given a category A response (highest priority, with a target response time of 8 minutes).

No patient categorized as stroke was given the lowest, category C response, but those categorized as nontraumatic falls were often given a category C dispatch. Yet 76% of patients who the caller said had collapsed or fallen were given a final diagnosis of stroke or transient ischemic attack.

"These findings suggest that EMD should elicit specific symptoms of stroke when evaluating patients with a reported fall or collapse," the researchers write in the International Journal of Stroke.

They add: "If stroke is suspected, members of the public should be encouraged to say the word stroke when contacting the EMS in order to initiate an immediate and appropriate response as outlined in the 'stroke chain of survival'."

By Eleanor McDermid

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