Mode of arrival to the emergency department of stroke patients in the United States.

BACKGROUND The modality of transport to the emergency department has implications for triage, evaluation, and treatment of patients with stroke. We performed this study to determine the national trends in modes of arrival in patients with stroke and its association with emergency department evaluation in a nationally representative sample of United States. METHODS We used the data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). The NHAMC is one of the largest studies designed to provide utilization and provision of services in hospital emergency departments (ED). Patients were categorized into three modes of arrival: 1) ambulance, either air or ground; 2) walk-in, this include car, taxi, bus, or foot; and 3) public services such as police car or social service vehicle/Unknown. RESULTS Of the 630,402 patients evaluated with stroke in the ED, the mode of arrival was by ambulance [331,760 (53%)], walk-in [271,268 (43%)], and public services/unknown [27374 (4%)]. The mean time for evaluation by a physician was 30±37 minutes, 34±44 minutes, and 55±105 minutes for ambulance, walk-in (P=0.535), and public services/unknown (P=0.664) mode of arrival, respectively. There was a trend for more frequent utilization of brain imaging in the patients presenting by ambulance (73%) compared to walk-in (63%, P=0.64) and public services/unknown (59%, P=0.5). Patients transferred by ambulance were more often admitted to the intensive care unit (11%) compared to walk-in (0.2%, P=0.02) and public services/unknown (6%, P=0.47). CONCLUSION Although arrival by ambulance was associated with a higher level of care, a prominent proportion of patients with suspected stroke are not arriving by ambulance to the ED.