Background: Stroke is a time-critical emergency in which rapid diagnosis and treatment are essential to improve outcomes. While Emergency Medical Services (EMS) facilitate structured prehospital stroke care, a proportion of patients bypass EMS and self-present to emergency departments (EDs), potentially causing treatment delays. This study compares process times and outcomes between EMS-transported and self-presenting stroke patients. Methods: We conducted a retrospective analysis of prospectively collected data from 1805 patients with suspected stroke admitted between May 2019 and June 2021 to two hospitals in Germany. Patients were classified as EMS-transported or self-presenting. Process times included door-to-needle time (DNT), symptom onset to first medical contact (FMC), and intravenous thrombolysis (IVT) rates. Data are presented as mean ± standard deviation or median interquartile range for continuous variables and as number (%) for categorical variables. Results: A total of 1940 patients with suspected stroke were included. For the main analysis comparing EMS transport and self-presentation, 1805 patients (1525 EMS, 280 self-presenting) were evaluated. EMS patients were significantly older than self-presenting patients (73.1 ± 15.1 vs. 65.3 ± 14.9 years, p < 0.001). The median time from symptom onset to first medical contact was 114 95–132 minutes in EMS patients and 727 420–1440 minutes in self-presenting patients (p < 0.001). IVT was administered in 119/1197 (9.9%) EMS patients and 18/254 (7.1%) self-presenting patients (p = 0.158) among those with documented information on thrombolysis. Door-to-needle time was slightly but significantly longer in self-presenting patients (median 35 32–54 vs. 30 28–34 minutes, p < 0.001), while both groups remained well within certification targets. Conclusions: Self-presenting stroke patients experienced markedly longer prehospital delays and lower intravenous thrombolysis rates compared to EMS-transported patients, although the difference in IVT rates was not statistically significant. In-hospital door-to-needle times were comparable between groups. These findings highlight the need for targeted public education to improve stroke symptom recognition and timely EMS activation.
Claudi et al. (Mon,) studied this question.
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