Emergency medical services utilization in acute stroke in Qatar - an observational cohort study

Introduction: Timely recanalization improves long-term outcomes in acute ischemic stroke (IS) patients, but most patients present outside the therapeutic window. Emergency Medical Services (EMS) can reduce pre-hospital delay and increase the likelihood of recanalization. We aim to determine the characteristic variations amongst suspected acute stroke patients using EMS. Methods: This retrospective observational study included all suspected acute stroke patients admitted to a national tertiary care hospital in Qatar from January 2014 to September 2020. We evaluated demographics, clinical features, treatment impact, and associated factors in EMS versus non-EMS transported groups. Results: During the study period, 11,892 patients presented with suspected stroke. Of these, 65.1% used EMS (EMS group) for transportation to the hospital. Median age was comparable between EMS and non-EMS group [52 years; IQR 43–63 vs. 43–62, p < 0.05]. Male to female ratio was 3:1. EMS use in the Qatari population (59.2%) was relatively low. Patients with hemorrhagic stroke (82.4%) had significantly higher EMS use as compared to IS (65.7%) and cerebral venous thrombosis (64.7%); p < 0.001. Symptom onset to ED presentation time was lower in EMS users, with 41.0% arriving within 4.5 h vs. 24.3% in the non-EMS transported group (p < 0.05). Patients with unilateral weakness (66.4%), aphasia (78.2%), neglect (78.2%), dysarthria (68.4%), loss of consciousness (83.3%), and seizures (83.9%) were more likely to use EMS than alternative modes of transportation. Patients attending via EMS had higher rates of thrombolysis than others (82.4% vs. 17.6%; p < 0.001) and a shorter door-to-needle time (56.4 ± 38.2 min vs. 75.7 ± 43.8 min; p < 0.001). Conclusion: EMS utilization in acute stroke patients was high and was associated with rapid and higher rates of therapeutic intervention. However, younger age, Arab ethnicity, and less obvious stroke symptoms were associated with lower EMS use, emphasizing the need for targeted public health interventions to improve EMS activations.