Abstract A119: Trends in Adherence to Prehospital Stroke Care Metrics in the US from 2017 to 2024

Introduction: Prehospital stroke care represents the critical first intervention in acute stroke management. It affects the eligibility and performance of reperfusion therapy and patient outcomes. We aimed to examine the recent national trends in Emergency Medical Services (EMS) adherence to American Heart Association (AHA) and Emergency Neurological Life Support (ENLS) prehospital stroke metrics. Methods: Among the 316,687,599 EMS activations in the National EMS Information System (NEMSIS) in the United States from 2017 to 2024, 1,145,643 encounters had impressions of stroke/TIA by both the dispatcher and EMS provider, and were assessed by advanced life support level crew. Eight AHA/ENLS metrics were assessed for compliance: stroke scale utilization, pre-notification, blood glucose measurement, blood oxygen level maintenance ≥94%, 12-lead ECG, symptom onset documentation, dispatch time ≤90 seconds, and response time ≤15 minutes. Results: A total of 1,145,643 encounters were evaluated from 2017 to 2024. Most of the metrics showed improvements over 8 years. Biggest improvements were seen in utilization of stroke scale (59.1% to 79.7%, p < 0.001), stroke pre-notification (32.3% to 53.6%, p< 0.001) and response time ≤ 15 minutes (52.4% to 67%, p < 0.001). Metrics with higher compliances from the beginning remained high with small increases, such as blood glucose measurement (82.9% to 87.4%, p < 0.001) and blood oxygen level maintenance ≥94% (84.7% to 93.5%, p < 0.001). Metrics that would shorten the time to acute stroke treatment, such as response time ≤ 15 minutes, dispatch time ≤ 90 seconds, and prenotification improved or remained stable, except symptom onset documentation which decreased from 2022 to 2024 (79.5% to 71.7%, p < 0.001). (Figure 1) Conclusions: EMS systems in the United States achieved improvement in key stroke quality metrics, but opportunities exist. More frequent use of stroke scale, recording of symptom onset, and prenotification can potentially reduce time to reperfusion therapy. It is important to further understand the barriers of low adherence in key metrics, and the impact of prehospital system improvement on the eligibility and time metrics of acute reperfusion treatment.