Clin Exp Emerg Med.  2017 Sep;4(3):168-177. 10.15441/ceem.16.147.

Effect of emergency medical service use on time interval from symptom onset to hospital admission for definitive care among patients with intracerebral hemorrhage: a multicenter observational study

• Kim DG
• Kim YJ
• Shin SD
• Song KJ
• Lee EJ
• Lee YJ
• Hong KJ
• Park JO
• Ro YS
• Park YM

• KMID: 2401246
• DOI: http://doi.org/10.15441/ceem.16.147

Abstract

OBJECTIVE
This study evaluated whether emergency medical service (EMS) use was associated with early arrival and admission for definitive care among intracerebral hemorrhage (ICH) patients.
METHODS
Patients with ICH were enrolled from 29 hospitals between November 2007 and December 2012, excluding those patients with subarachnoid hemorrhage, traumatic ICH, and missing information. The patients were divided into four groups based on visit type to the definitive hospital emergency department (ED): direct visit by EMS (EMS-direct), direct visit without EMS (non-EMS-direct), transferred from a primary hospital by EMS (EMS-transfer), and transferred from a primary hospital without EMS (non-EMS-transfer). The outcomes were the proportions of participants within early (<1 hr) definitive hospital ED arrival from symptom onset (pS2ED) and those within early (<4 hr) admission from symptom onset (pS2AD). Adjusted odds ratios were calculated to determine the association between EMS use and outcomes with and without inter-hospital transfer.
RESULTS
A total of 6,564 patients were enrolled. The adjusted odds ratios (95% confidence intervals) for pS2ED were 22.95 (17.73-29.72), 1.11 (0.67-1.84), and 7.95 (6.04-10.46) and those for pS2AD were 5.56 (4.70-6.56), 0.96 (0.71-1.30), and 2.35 (1.94-2.84) for the EMS-direct, EMS-transfer, and non-EMS-direct groups compared with the non-EMS-transfer group, respectively. Through the interaction model, EMS use was significantly associated with early arrival and admission among direct visiting patients but not with transferred patients.
CONCLUSION
EMS use was significantly associated with shorter time intervals from symptom onset to arrival and admission at a definitive care hospital. However, the effect disappeared when patients were transferred from a primary hospital.

Keyword

Intracranial hemorrhages; Emergency medical services; Patient admission; Time

MeSH Terms

Cerebral Hemorrhage*
Emergencies*
Emergency Medical Services*
Emergency Service, Hospital
Hospitals
Humans
Intracranial Hemorrhages
Observational Study*
Odds Ratio
Patient Admission
Subarachnoid Hemorrhage, Traumatic