Early Management of Patients with Suspected Acute Stroke: the ``EpisignAVC'' Study

Aims: Patients with suspected acute stroke need fast management. That is why, in France, a specific pathway has been set up for the management of those patients. It is named ``neurovascular pathway''. The aim of this study was to describe the initial diagnosis and care pathway of patients with suspected acute stroke in the French health system (prehospital and emergency department). Procedure: A short prospective observational study during 3 days in 35 emergency medical services (EMS) call centers, 27 physician-staffed EMS ambulances and 85 emergency departments in France, enrolling every patient over 18 with symptoms suggestive of an acute stroke. Patients were either or not managed in the neurovascular pathway. Results: From November 29 to December 1, 2016, 827 patients have been enrolled, mean age 68. Among them, 418 were diagnosed with an acute stroke, including 231 with acute ischemic stroke. The initial care was managed in the neurovascular pathway in 279 patients (44 %). The median time before seeing a physician was 3h49. It was significantly shorter in the neurovascular pathway (2 h 45 vs. 5 h 56; p < 0.001). Conclusion: In France, management of patients with suspected acute stroke follows a specific pathway in only half of the cases. This pathway needs to be promoted.