Abstract T MP51: Concordance of Emergency Medical Services and Neurology Times Last Seen Normal in Acute Ischemic Stroke Patients

Background and Purpose: The establishment of a patient’s time last seen normal (TLSN) is an important step for medical decision making in the current treatment paradigm of acute ischemic stroke patients. While both emergency medical services (EMS) and neurologists evaluate stroke patients, there is limited data on the concordance of TLSN as determined by the two groups. The purpose of our study was to identify the frequency of clinically significant differences between reported TLSN by EMS and neurology providers. Methods: We performed a retrospective chart review of acute ischemic stroke patients brought in to Emory University Hospital by EMS who were treated with IV thrombolysis from January 2010 to April 2013 to obtain the TLSN. For this analysis, we included only those patients who had documentation of TLSN by both EMS and neurology providers. A clinically significant difference between reported TLSN by EMS and neurology providers was defined as a discrepancy >30 minutes. Results: Of 131 patients who were brought in by EMS and received IV thrombolysis during the study period, 109 (83%) had documentation of TLSN by both EMS and neurology providers (mean age 69.6 ± 16.5 years; 51% female). EMS and neurology providers reported the same TLSN in only 44% of cases. However, a difference of >30 minutes between the 2 groups was found in only 15% of cases. In a multivariable logistic regression analysis, the only variable found to be a predictor of discrepancy >30 minutes between EMS and neurology providers was first medical contact in the morning (midnight to 10 AM)(p=0.02); race, sex, EMS provider company, and baseline NIHSS score were not predictors. Conclusion: While TLSN obtained by EMS and neurology providers varied in more than half of patients, only 15% of cases had a >30 minute discrepancy. Acute ischemic stroke patients presenting in the morning were more likely to have a clinically significant difference in TLSN reported by EMS and neurology providers.