Impact of a novel pre-hospital stroke notification programme on acute stroke care key performance indicators in Hong Kong: a multicentre prospective cohort study with historical controls

Introduction:Early identification and initiation of reperfusion therapy is essential for suspected acute ischaemic stroke.A pre-hospital stroke notification (PSN) protocol using FASE (facial drooping, arm weakness, speech difficulties, and eye palsy) was implemented to improve key performance indicators (KPIs) in acute stroke care delivery.We assessed KPIs and clinical outcomes before and after PSN implementation in Hong Kong.Methods: This prospective cohort study with historical controls was conducted in the Accident and Emergency Departments of four public hospitals in Hong Kong.Patients were screened using the PSN protocol between August 2021 and February 2022.Suspected stroke patients between August 2020 and February 2021 were included as historical controls.Door-to-needle (DTN) and door-to-computed tomography (DTC) times before and after PSN implementation were compared.Clinical outcomes including National Institutes of Health Stroke Scale score at 24 hours and modified Rankin Scale score at 3 months after intravenous recombinant tissue-type plasminogen activator (IV-rtPA) were also assessed.Results: Among the 715 patients (266 PSN and 449 non-PSN) included, 50.8% of PSN patients and 37.7% of non-PSN patients had a DTC time within 25 minutes (P<0.001).For the 58 PSN and 134 non-PSN patients given IV-rtPA, median DTN times were 67 and 75.5 minutes, respectively (P=0.007).The percentage of patients with a DTN time within 60 minutes was higher in the PSN group than in the non-PSN group (37.9% vs 21.6%; P=0.019).No statistically significant differences in clinical outcomes were observed.