Examining the pre-hospital workflow of stroke patients referred with SAMA code (724) and their outcome in the emergency room of Imam Reza Hospital (AS)

Abstract

SAMA code is a stroke code in pre-hospital emergency in Iran, which is implemented for time management and treatment of patients with possible stroke and positive FAST symptoms. The purpose of this study is the workflow of patients with stroke symptoms transmitted by SEMA code.

Method: All patients with neurological symptoms who were brought to Imam Reza (AS) hospital during the years 1400 and 1401 with the activation of the SAMA code by the pre-hospital emergency department were included in the study. Based on the documents available in the pre-hospital emergency room and registry, the patients who came from the beginning with the activation of the SAMA code were extracted. The data includes the age and sex of the patient, the time of calling the emergency room, the time of code activation, the time of staff presence at the patient's bedside, the clinical findings recorded in the pre-hospital file, the time of arrival at the emergency room and entering the CT scan, the time of thrombolytic therapy, The reason for canceling the intensity of the injection and finally the outcome of the patient were recorded in the emergency room.

Results: In this study, 880 patients were included in the study, based on which the average age of the patients was 69.24 ± 14.14 (68.30-17.17, 95% CI), the median age of the patients was 71 years, and the median age was 61. It was up to 80 years. In examining the gender distribution of patients, 505 patients (57.4%) were male and 375 patients (42.6%) were female. The number of patients referred by the pre-hospital emergency was almost the same with the activation of the SAMA code in two years. The median time interval between notification to the pre-hospital emergency room and the start of the mission was 1 minute with a median of 0 to 1 minute. The average time interval between the start of the mission and reaching the patient's bed was 10 minutes with a median of 7 to 15 minutes. The median time interval between the arrival of the pre-hospital emergency at the patient's bedside and the transfer of the patient was 18 minutes with a median of 12 to 21 minutes. The median time interval between the start of the patient transfer by the pre-hospital emergency and the arrival at the hospital was 10 minutes with a median of 11 to 26 minutes. The median time between the patient's arrival at the hospital and the CT scan was 17 minutes, with a range of 17 to 38 minutes. Out of 880 patients, 750 patients were admitted to the hospital, out of which, in the same triage for 13 patients, the SAMA code was canceled and they were triaged with the possibility or diagnosis of other diseases, and 737 patients underwent CT scan. Out of 737 patients, only 20 patients were treated with thrombolytics. In patients who have become candidates for thrombolytic therapy, patients have been treated with a median interval of 20 minutes between CT scan and treatment and with a median interval of 13 to 34 minutes.