Abstract
"Background
Stroke is a leading cause of death and disability. Emergency medical services (EMS) play a role in the recognition and management of patients. Prior to 2019, national guidelines for UK EMS recommended clinicians consider recording a prehospital ECG (PHECG) for stroke patients, however this recommendation was based on expert consensus, rather than evidence. This thesis examined the use and impact of EMS recording PHECG in acute stroke patients.
Methods
A systematic review was conducted to examine the use and impact of PHECGs in stroke patients, focusing on the prevalence of abnormalities and effect on prognosis and outcome. The results led to an overarching research question: what is the use and impact of PHECGs in acute stroke patients? A mixed methods study was conducted, incorporating a retrospective cohort study (Study 1) and cross-sectional qualitative interview study (Study 2). To answer the overarching research question, the findings were integrated.
Findings
Study 1 demonstrated an association between PHECG and worse functional outcome at hospital discharge; higher mortality; and no difference in hospital processes of care.
Study 2 found that paramedics have mixed attitudes towards PHECGs for stroke patients. Paramedic decision-making on recording PHECGs relies on intuitive and quasi-rational cognitive modes and requires a number of clinical, logistical and ethical considerations.
A greater understanding of the overarching research question was gained by integrating the findings of both studies. Half of patients enrolled in to Study 1 received PHECGs. This may be explained by the perceived relevance of the test; a paucity of research; weight given to national guidelines; patient and EMS staff gender. The lack of clinical benefit and prehospital time delays may be explained by factors other than recording of the PHECG, such as the first responding EMS resource, the background of the EMS crew and their experiences.
Conclusions
This thesis is the most comprehensive project investigating the use and impact of PHECG for stroke patients that has been undertaken to date. The findings from this thesis have informed national EMS guidelines and generated recommendations for future practice and research."