Medical attention seeking by suspected stroke patients: Emergency medical services or general practitioner?

Martijne H.C. Duvekot*, Henk Kerkhoff, Esmee Venema, Hans W.D.J.C. Bos, David Smeekes, Bianca Ivonne Buijck, Anouk D. Rozeman, Walid Moudrous, Frédérique H. Vermeij, Geert J. Lycklama à Nijeholt, Pieter Jan van Doormaal, Adriaan C.G.M. van Es, Aad van der Lugt, Diederik Dippel, Bob Roozenbeek

*Corresponding author for this work

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Objective: Awareness campaigns advise the public to call emergency medical services (EMS) directly in case of suspected stroke. We aimed to explore patient and notification characteristics that influence direct EMS notification, the time to alert, and the time to treatment. Methods: We performed a secondary analysis with data from the PRESTO study, a multi-center prospective observational cohort study that included patients with suspected stroke. We used multivariable binary logistic regression analyses to assess the association with direct EMS notification and multivariable linear regression analyses to assess the association with the onset-to-alert time, onset-to-needle time and onset-to-groin time. Results: Of 436 included patients, 208 patients (48%) contacted EMS directly. FAST scores (aOR 1.45 for every point increase, 95%CI: 1.14–1.86), alert outside office hours (aOR 1.64 [1.05–2.55]), and onset-to-alert time (aOR for every minute less [≤55 min]: 0.96 [0.95–0.97]) were independently associated with direct EMS notification. Direct EMS call was independently associated with shorter onset-to-alert times (27 min [54–0.84]) and with shorter onset-to-needle times (−30 min [−51 to −10]). The association between direct EMS call and the onset-to-groin time was almost similar to the association with onset-to-needle time, though not statistically significant (univariable analysis: 23.7 min decrease [−103.7 to 56.2]). Conclusion: More than half of all patients with suspected stroke do not call EMS directly but call their GP instead. Patients with higher FAST scores, alert outside office hours, and a rapid alert, more often call EMS directly. Patients who call EMS directly are treated with IVT 30 min faster than patients who call the GP first. Trial registration number: Netherlands Trial Register: NL7387, (

Original languageEnglish
Article number107297
JournalClinical Neurology and Neurosurgery
Early online date25 May 2022
Publication statusPublished - Jul 2022

Bibliographical note

Funding Information:
Diederik Dippel and Aad van der Lugt report funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker, Stryker European Operations BV, Medtronic, Thrombolytic Science, LLC and Cerenovus for research, all paid to institution. Bob Roozenbeek reports funding from the Dutch Heart Foundation and The Netherlands Organisation for Health Research and Development, paid to institution. Pieter Jan van Doormaal reports funding from Stryker, paid to institution and an unrestricted fee from Bayer. All other authors declare no conflict of interest.

Funding Information:
This study was funded by the BeterKeten Collaboration (the Netherlands) and Theia Foundation (Zilveren Kruis, the Netherlands). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Publisher Copyright:
© 2022 The Authors


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