Etiology and clinical characteristics of patients with severely impaired consciousness in prehospital settings: A retrospective study.

Aim: To examine the causes of patients with severely impaired consciousness and the clinical characteristics in prehospital settings that are useful for differential diagnosis, especially stroke. Methods: We retrospectively examined patients aged ≥16 years with Japan Coma Scale III-digit codes during paramedic contact and transported to our hospital between January 2018 and December 2018. Furthermore, we examined background and physical findings of patients at final diagnosis, and also examined factors associated with stroke. Results: Overall, 227 patients were included in this study. One hundred and twelve patients (49.3%) were male, and the median age was 71 years (interquartile range, 50-83 years). Stroke was the most common cause (30%). Intoxication and psychiatric disorders were significantly more common in younger patients (p < 0.01). Systolic blood pressure was the highest in patients with stroke. Mortality was the highest in stroke (55.9%). Systolic blood pressure, airway compromise, and ocular abnormalities were factors associated with stroke, with odds ratios of 1.03 (95% confidence interval [CI], 1.02-1.04), 6.88 (95% CI, 3.02-15.64), and 3.86 (95% CI, 1.61-9.27), respectively. Conclusion: Stroke was the most common cause of severely impaired consciousness. Age could be a useful indicator to consider intoxication and psychiatric disorders. Systolic blood pressure, airway compromise, and ocular abnormalities were factors associated with stroke in the prehospital setting.

[Effects of the prehospital care with and without suspecting acute stroke: a single stroke center study].

We retrospectively examined the differences between paramedic triage and final diagnosis in the cases that were transported to our hospital between May 2016 and March 2019. About 30% of the patients with suspected stroke were diagnosed other than stroke. Some of the patients without suspected stroke were diagnosed with large vessel occlusion and were treated with mechanical thrombectomy. The time from arrival at the hospital to treatment was significantly longer in the patients without suspected stroke than with suspected stroke. To achieve a better prehospital care, we need to accept a wide range of stroke mimics, and to continuously feedback the paramedics about the importance of paralysis, cortical symptoms in stroke.