Abstract WP243: Identification of Common Confounders in the Prehospital Identification of Stroke in Urban, Underserved Minorities

Background: Pre-hospital providers report positive predictive values (PPV) of 40-85% for the diagnosis of stroke, typically using the Cincinnati Pre-hospital Stroke Scale. In New York City 911, both emergency medical technicians [Basic Life Support (BLS)] and paramedics [Advanced Life Support (ALS)] care for/transport stroke patients. Hypotheses: (1) In an urban, underserved, minority population, ALS would have greater PPV than BLS for the confirmed diagnosis of stroke, and (2) Hypoglycemia and seizures would be frequent confounders, particularly for BLS providers. Methods: After IRB approval, medical records were reviewed of patients (85% Carribean Blacks) transported by EMS to participating Brooklyn facilities from 1/1/10-12/31/11. We compared EMS impressions of the presenting problem with AHA/ASA “Get with the Guidelines” (GWTG) databases - serving as the gold standard for diagnosis of stroke/TIA. Medical records of patients thought to have stroke by EMS but without a GWTG stroke diagnosis were queried...