Increasing age is associated with poorer access to acute stroke care but not because of pre-hospital misdiagnosis.
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Authors
Rudd, Matthew
Harrison, A.
Price, Christopher
Issue Date
2014
Type
Article
Language
en
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Abstract
Introduction: Older age has been associated with reduced access to stroke unit care but it is unclear whether this simply reflects difficulties with early clinical diagnosis (Rudd, Hofman, Down et al Age and Ageing 200736247-55). We examined whether pre-hospital recognition of stroke and access to acute stroke care were related to age.
Methods: Northumbria Healthcare NHS Foundation Trust is a large geographical secondary care provider with 3 separate acute stroke units (ASU). All patients are initially assessed in the associated emergency department (ED). We retrospectively linked the medical records of patients with a discharge diagnosis of stroke between 14thMay 2012 and 10th June 2013 with the corresponding electronic patient report forms completed by paramedics on admission. Only patients admitted by emergency ambulance were included.
Results: 733 of 1039 confirmed stroke admissions arrived by emergency ambulance. Complete data was available for 539/733 patients. There was no association between age and presence (n = 422, median age 79yrs) or absence (n = 117, median age 81yrs) of a paramedic diagnosis of stroke (p = 0.52). 392/422 patients with a paramedic diagnosis of stroke were admitted to ASU or ICU. The 30 patients admitted to other wards were older (median 84yrs (other ward) versus 79yrs (ASU/ICU), p = 0.01). 77/117 patients without a paramedic diagnosis of stroke were admitted to ASU or ICU. The 40 admitted to other wards were not significantly older (median age 82.5 (other ward) versus 80 (ASU/ICU), p = 0.52).
Discussion: Increasing age was not associated with pre-hospital identification of stroke but older patients identified in the pre-hospital phase were less likely to access the ASU directly from ED. This may be due to confounding diagnostic factors emerging in ED, or a higher threshold for admission to the ASU when patients are older.
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Citation
Rudd, M.P., Martin, A., Harrison, A., Price, C. (2014) 66 Increasing age is associated with poorer access to acute stroke care but not because of pre-hospital misdiagnosis. Age and Ageing;�43�(Suppl 2) : ii20.
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Journal
Age and Ageing
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PubMed ID
ISSN
1468-2834