References
Comparison of prehospital stroke care at private homes and residential care settings
Abstract
Background:
Suspected stroke is a common scenario among care home residents, who are typically older and have more complex health needs than the general population.
Aims:
The aim of this study was to describe the care of suspected stroke patients according to their residential status.
Methods:
Retrospective secondary analysis was carried out using a clinical record dataset from a UK ambulance service that described the care of patients labelled as having a suspected stroke between December 2021 and April 2022.
Findings:
Care home patients were older (median age 86 (interquartile range (IQR) 79–91) years) than those in their own homes (median age 75 (IQR 63–83) years; P≤0.001), with more comorbidities (median of five (IQR 3–6) versus median of three (IQR 2–5); P≤0.001) and taking more medications (median of six (IQR 4–9) versus median of four (IQR 1–7); P≤0.001). They were more likely to have difficulties completing the face, arms, speech, time test (17/170 (10%) versus 39/1305 (3%); P≤0.001) and present with facial droop (85/153 (55.6%) versus 506/1266 (40%); P≤0.001). Ambulance on-scene time was longer at care homes (median 41 (IQR 32–49.5) minutes versus median 35 (IQR 27–45) minutes; P≤0.001).
Conclusion:
Clinician awareness of characteristics associated with residential settings may be important for delivering emergency stroke care. Research is needed to optimise ambulance assessment for care home patients.
Stroke is defined as a neurological deficit attributed to an acute focal injury of the central nervous system by a vascular cause. As it is a common, time-sensitive medical emergency with a high mortality rate (Sacco et al, 2013; Sibson, 2017), prehospital care focuses on early recognition and rapid transportation to an appropriate hospital for treatment (Sibson, 2017). A significant proportion of patients with stroke symptoms are later diagnosed with a non-stroke mimic condition (Winkler et al, 2009), while some spontaneously improve after initial assessment and the condition is labelled a transient ischaemic attack (TIA) (McClelland et al, 2020). Nonetheless, the emergency response should continue until stroke has been excluded.
Approximately 340 000 older people in England are living in care homes across the UK (Wolters et al, 2019). These are split into two main types: nursing homes providing 24-hour personalised nursing care; and residential homes providing assistance with daily activities only (Wolters et al, 2019).
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