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dc.contributor.authorSammut-Powell, Camilla; email: Camilla.sammut-powell@manchester.ac.uk
dc.contributor.authorAshton, Christopher
dc.contributor.authorParoutoglou, Kyriaki
dc.contributor.authorParry-Jones, Adrian
dc.date.accessioned2021-05-24T05:12:54Z
dc.date.available2021-05-24T05:12:54Z
dc.date.issued2021-05-10
dc.date.submitted2020-12-24
dc.identifierhttps://chesterrep.openrepository.com/bitstream/handle/10034/624679/additional-files.zip?sequence=2
dc.identifierhttps://chesterrep.openrepository.com/bitstream/handle/10034/624679/fneur-12-646015.xml?sequence=3
dc.identifierhttps://chesterrep.openrepository.com/bitstream/handle/10034/624679/fneur-12-646015.pdf?sequence=4
dc.identifier.citationFrontiers in Neurology, volume 12, page 646015
dc.identifier.urihttp://hdl.handle.net/10034/624679
dc.descriptionFrom Frontiers via Jisc Publications Router
dc.descriptionHistory: received 2020-12-24, collection 2021, accepted 2021-03-08, epub 2021-05-10
dc.descriptionPublication status: Published
dc.description.abstractBackground: In Greater Manchester (GM), prehospital clinicians use the Face Arm Speech Test (FAST) to identify suspected stroke patients alongside pathway exclusions. Within the centralized stroke service, patients with a suspected stroke are taken directly to a Hyper Acute Stroke Unit (HASU), often bypassing their local emergency department (ED). However, many of these patients are experiencing an illness that looks like a stroke but is not a stroke. The data collected in the prehospital setting is rarely used in research yet could give valuable insights into the performance of the pathway. Aim: To evaluate the presenting symptoms and final diagnoses of prehospital suspected strokes and to evaluate the adherence of prehospital stroke pathway exclusions. Methods: We analyzed data from all patients brought in by ambulance and admitted on the stroke pathway between 01/09/15 and 28/02/17. Patient demographics and all data recorded in the prehospital setting were evaluated to identify differences in stroke, TIA, and mimic patients. Pathway adherence was assessed according to whether the patient was local or out-of-area (OOA) and bypassed their local ED. Results: A total of 4,216 suspected strokes were identified: 2,213 (52.5%) had a final diagnosis of stroke, 492 (11.7%) experienced a transient ischemic attack (TIA), and 1,511 (35.8%) were stroke mimics. There were 714 (16.9%) patients that were identified as having at least one pathway exclusion or were FAST negative, of which 270 (37.8%) experienced a stroke. The proportion of strokes was significantly lower in those with a pathway exclusion (41.8 vs. 53.5%; p < 0.001) and the proportion of breaches tended to be comparable or higher in the local population. Discussion: There are high volumes of stroke mimics but identified differences indicate there is an opportunity to better utilize prehospital data. Ambulance clinicians were able to correctly overrule FAST negative results and the volume of these suggest that FAST alone may be too restrictive.
dc.languageen
dc.publisherFrontiers Media S.A.
dc.rightsLicence for this article: http://creativecommons.org/licenses/by/4.0/
dc.sourceeissn: 1664-2295
dc.subjectNeurology
dc.subjectstroke recognition
dc.subjectstroke mimics
dc.subjectprehospital/EMS
dc.subjectpathway exclusions
dc.subjectsuspected stroke
dc.titleDifferences in Characteristics and Ambulance Pathway Adherence Between Strokes and Mimics Presenting to a Large UK Centralized Hyper Acute Stroke Unit (HASU)
dc.typearticle
dc.date.updated2021-05-24T05:12:54Z
dc.date.accepted2021-03-08


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