Emergency Department Companions of Stroke Patients

Acute care of stroke victims largely relies on the rapid identification and timely clinical and radiological assessment. We evaluated the effect of the number of patient companions on the efficiency of the diagnostic process in the emergency department (ED). Consecutive stroke patients admitted to the ED between August 2011 and October 2012 were evaluated. Clinical, epidemiological, and timeline data (symptoms onset, ED arrival, computed tomography [CT] scanning, and recombinant tissue plasminogen activator infusion), as well as the number of accompanying persons in the ED were prospectively recorded. We used multivariate Poisson log linear models to analyze the association of number of companions adjusted and door-toCT times and logistic regression for the analysis of the successful identification of stroke patient by ED triage nurse. Out of a total of 724 stroke patients admitted, data regarding number of ED companions were available for 610 (84.3%) patients. Number of companions was associated with higher National Institute of Health Stroke Scale and speech disturbances. It was found to be independently associated with shorter time to CT scanning adjusted for the stroke severity, sex, and speech disturbances (no companions as a reference group, relative risks 0.82, 0.73, and 0.70 for 1, 2, and 3 companions, respectively, all P< 0.001). Similarly, number of companions was associated with higher rates of stroke recognition by the triage nurse adjusted for covariates (odds ratios 2.11, 2.62, and 4.11, respectively, all P< 0.05). Our findings suggest that the family members and other companions could serve as facilitators of faster and more effective ED management of stroke patients, possibly improving their outcome. (Medicine 94(9):e520) Abbreviations: CI = confidence interval, CT = computed tomography, ED = emergency department, EMS = Emergency ctor Novack, MD, Iluz, RN, , and Gal Ifergane, MD SUMC = Soroka University Medical Center, TIA = transient ischemic attack. INTRODUCTION T he quality of the acute care of stroke victims largely relies on the rapid identification, clinical and radiological assessment, coordination of emergency physicians, neurologists, and radiologists, and management of the patient. The guidelines for the early management of patients with acute ischemic stroke (IS) state that emergency department (ED) patients with suspected acute stroke should be triaged with the same priority as patients with acute myocardial infarction or serious trauma regardless of the severity of neurological deficits. Even patients with mild or rapidly improving stroke symptoms may have a poor final stroke outcome, and are currently considered candidates for thrombolytic therapy. Therefore, efforts are directed toward accelerating the triage process and identifying factors associated with the delay. Family presence may influence the conduct of the diagnostic and treatment processes. For example, the effect of family presence during cardiopulmonary resuscitations and invasive procedures was extensively investigated during the last decade. Many patients and family members wish to be given the option, and health care providers generally support it. Nevertheless, the policy of the ED often limits the presence of family members to avoid crowding. The number of persons wishing to accompany a patient in the ED in general, and a stroke patient in particular, may be affected by multiple factors—disease-related (severity, symptoms, and time of onset) and nondisease-related (cultural, familial, and personal). In this prospective study, we attempted to evaluate the effect of the number of companions on the efficiency of the diagnostic process in ED, that is, likelihood of recognition by the triage nurse and time from door to computed tomography (CT).