Pre-hospital emergency medical care for patients with acute cerebrovascular disorder in Latvia: Descriptive retrospective observational study
Title: Pre-hospital emergency medical care for patients with acute cerebrovascular disorder in Latvia: descriptive retrospective observational study.
Background: Cardiovascular diseases (CVD) are the leading cause of death in Latvia – 56.3% of all deaths in 2016. Cerebrovascular diseases, including stroke, is the second leading cause of death in Latvia, accounting for 19.0% of all deaths in 2016. Besides stroke is not only the major cause of long-term disability, but also the main cause of epilepsy and the second most common cause of dementia in the elderly people. As thrombolytic therapy is not provided by prehospital emergency medical care (EMC) ambulance team, patient outcomes mostly depends on timely delivery of medical care in hospital, i.e. time window 4 – 4,5 h.
Objective: To evaluate EMC for patients with acute cerebrovascular syndrome (ACS) in Latvia year 2017 by analyzing State Emergency Medical Service (SEMS) patient electronical medical records.
Material and methods: Electronical medical records of 11 360 patients with ACS in 2017 were analyzed. Medical records were selected by International Statistical Classification of Diseases and Related Health Problems – 10th revision diagnoses I60 – 164.
Conclusions:
1. There were 11 360 ambulance teams visits to patients with stroke (I60 – I64) - 6644 (58,5%; CI 57.58 - 59.39) were women and 4716 were men (41,5%; CI 40.61 - 42.42).
2. Emergency medical dispatcher recognised stroke signs in 38.8 % of cases (n=4411) as the most common reason for call was paralyses. In 77.8 % of cases (n=8827) dispatcher recognised signs of ACS as other call reasons were “Feeling bad, can’t explain the reason”, “Unconscious, breathing, cause unknown”, “Syncope”, “Dizziness”, “Behavioral disorders”, “Sudden headache”, “High blood preasure” etc.
3. Average response time in 2017 was 9.3 minutes (CI 9.11 - 9.49) in urban areas and 17.7 minutes in rural areas (CI 17.41 - 17.99). Compared to 2011, average response time in the rural areas decreased by 2.2 minutes that can be explained by changes in work organization and information systems.
4. Transportation time in urban areas was 23.1 (CI 22.75-23.45) minutes, while in rural areas it was 34.5 minutes (CI 33.89 - 35.11).
5. Total time from the receipt of call till patient’s hospitalization accounts for 66 minutes (CI 65.48 - 66.52) in urban areas and 84 minutes (CI 83.12 - 84.88) in rural areas that corresponds to time window, i.e. golden hour (60 – 90 minutes).
6. Despite the timely delivery of patients to hospital, mortality from stroke remains high in Latvia that requires not only prehospital but in hospital data analyses also to better understand factors affecting medical care of patients with stroke. Data is required from Clinical University hospital and will be analyzed up to September 2018.
7. For more efficient and operative data analyses in identifing patient outcomes unified health care database must be established that would be a crucial investment in health care quality improvement in Latvia.
