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Time intervals and distances travelled for prehospital ambulance stroke care: data from the randomised-controlled ambulance-based Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2)

Dixon, Mark; Appleton, Jason P.; Scutt, Polly; Woodhouse, Lisa J.; Haywood, Lee J.; Havard, Diane; Williams, Julia; Siriwardena, A. Niroshan; Bath, Philip M.

Time intervals and distances travelled for prehospital ambulance stroke care: data from the randomised-controlled ambulance-based Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2) Thumbnail


Authors

Mark Dixon

Jason P. Appleton

Polly Scutt

Lee J. Haywood

Diane Havard

Julia Williams

A. Niroshan Siriwardena

PHILIP BATH philip.bath@nottingham.ac.uk
Stroke Association Professor of Stroke Medicine



Abstract

Objectives
Ambulances offer the first opportunity to evaluate hyperacute stroke treatments. We investigated the conduct of a hyperacute stroke study in the ambulance-based setting with a particular focus on timings and logistics of trial delivery.

Design
Multicentre prospective, single-blind, parallel group randomised controlled trial.

Setting
Eight NHS ambulance services in England and Wales; 54 acute stroke centres.

Participants
Paramedics enrolled 1,149 patients with likely stroke, face, arm speech (2 or 3), within four hours of symptom onset and systolic BP>120mmHg.

Interventions
Paramedics administered randomly assigned active transdermal glyceryl trinitrate or sham.

Primary and Secondary Outcomes
Modified Rankin scale at day-90. This paper focuses on response time intervals, distances travelled and baseline characteristics of patients, compared between ambulance services.

Results
Paramedics enrolled 1,149 patients between September 2015 and May 2018. Final diagnosis: intracerebral haemorrhage 13%, ischaemic stroke 52%, TIA 9%, mimic 26%. Timings (minutes) were (median [25, 75 centile]): onset to emergency call 19 [5, 64]; onset to randomisation 71 [45, 116]; total time at scene 33 [26, 46]; depart scene to hospital 15 [10, 23]; randomisation to hospital 24 [16, 34] and onset to hospital 97 [71, 141]. Ambulances travelled (km) 10 [4, 19] from scene to hospital. Timings and distances differed between ambulance service, e.g. onset to randomisation (fastest 53, slowest 77 minutes; p<0.001), distance from scene to hospital (least 4, most 20 km; p<0.001).

Conclusion
We completed a large pre-hospital stroke trial involving a simple-to-administer intervention across multiple ambulance services. The time from onset to randomisation and modest distances travelled support the applicability of future large-scale paramedic-delivered ambulance-based stroke trials in urban and rural locations.

Citation

Dixon, M., Appleton, J. P., Scutt, P., Woodhouse, L. J., Haywood, L. J., Havard, D., …Bath, P. M. (2022). Time intervals and distances travelled for prehospital ambulance stroke care: data from the randomised-controlled ambulance-based Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2). BMJ Open, 12(11), Article e060211. https://doi.org/10.1136/bmjopen-2021-060211

Journal Article Type Article
Acceptance Date Sep 19, 2022
Online Publication Date Nov 21, 2022
Publication Date Nov 21, 2022
Deposit Date Sep 21, 2022
Publicly Available Date Sep 21, 2022
Journal BMJ Open
Electronic ISSN 2044-6055
Peer Reviewed Peer Reviewed
Volume 12
Issue 11
Article Number e060211
DOI https://doi.org/10.1136/bmjopen-2021-060211
Public URL https://nottingham-repository.worktribe.com/output/11466850
Publisher URL https://bmjopen.bmj.com/content/12/11/e060211

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