Time Disparities in Stroke Access to Care: A Prospective Comparative Study of Patients Transported by Emergency Medical Services Stroke Pathway Versus Private cars in Riyadh, Saudi Arabia

Author(s): Abdullah Ahmad Alabdali, Afnan Ayidh Alqahtani, Alanowd Suliman Alghaith, Reem Ahmed Alowayid, Shaden Mohammad Alsagri, Alanwd Deyab Alshamari, Ali Matouq Alsaleh, Omar Aldibasi, Fahmi M. Al-Senani

Background: Stroke is an emergency condition that can lead to a long-term disability or death if not recognized early and managed properly. Emergency Medical Services (EMS) providers have a significant role in recognizing, stabilizing, and transporting suspected stroke patients to the nearest appropriate facility. Recently a new stroke pathway has been implemented in Riyadh, Saudi Arabia, in which suspected stroke patients will be transported immediately to King Fahad Medical City (KFMC) and the stroke team will be notified prior to the patient's arrival. This research aims to compare the stroke patients' times of care access for patients transported by EMS using the new stroke pathway with those transported by private cars.

Methods: This was a prospective study conducted in KFMC from 17th of January to 31st of December 2022, focusing on adult patients whose stroke code was activated during that year. Patients' characteristics, times of care access, and their 90 days mortality outcomes were collected. SAS Software Version 9.4 (SAS Institute Inc., Cary, North Carolina, USA) was used for analysis.

Results: A total of 478 patients were included in the study, 173 of them were transported by EMS while the other 305 were brought by private cars. The majority of the EMS group were categorized as moderate, moderate to severe, and severe based on the National Institutes of Health Stroke Scale (NIHSS), compared to the majority of the private car group who were categorized as moderate, minor, and severe. The median time of stroke care access in KFMC was shorter and statistically significant for the EMS group. Additionally, there was no statistical difference in mortality between the EMS group and the private car group (P value = 0.2826).

Conclusion: In conclusion, there was a statistical difference in times of care access between the two groups indicates that patients transported by EMS using the new stroke pathway have received care faster than those who transported by private cars.