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Background <p>Timely reperfusion is a&#xa0;major determinant of outcome in acute ischemic stroke. Prehospital emergency medical services (EMS) may facilitate faster hospital access and earlier treatment initiation, thereby influencing survival.</p> Objectives <p>To evaluate the association between EMS utilization, treatment delays, and in-hospital mortality among patients with acute ischemic stroke receiving reperfusion therapy, and to explore whether the mode of hospital arrival is associated with outcomes beyond treatment timing.</p> Materials and methods <p>This retrospective observational cohort study included adult patients who underwent reperfusion therapy at a&#xa0;tertiary center between January and December 2024. Patients were categorized according to mode of arrival (EMS vs. non-EMS). Treatment time metrics, reperfusion modality, length of hospital stay, and in-hospital mortality were compared. Multivariable logistic regression analysis was performed to identify independent predictors of mortality.</p> Results <p>A&#xa0;total of 251 patients were analyzed, 67.0% of whom arrived via EMS. Patients transported by EMS had significantly shorter median onset-to-treatment times (150 vs. 254 min; <i>p</i> &lt; 0.001) and door-to-treatment times (69 vs. 134 min; <i>p</i> &lt; 0.001). In-hospital mortality was significantly lower in the EMS group (17.3% vs. 59.5%; <i>p</i> &lt; 0.001). In multivariable analysis, increasing treatment delay (odds ratio [OR]: 1.016), older age, and baseline stroke severity were independent predictors of mortality.</p> Conclusion <p>Utilization of EMS was associated with shorter treatment delays and lower in-hospital mortality among patients receiving reperfusion therapy. These findings suggest that, beyond reducing delays, EMS use may reflect more efficient stroke care pathways that contribute to improved clinical outcomes.</p> Graphic abstract <p></p>

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Emergency medical services and in-hospital mortality in acute ischemic stroke

  • 期刊论文

  • 发表日期：

    2026年7月3日

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  • Furkan Yılmaz,
  • Kadir Yenal,
  • Burak Bekgöz

摘要

Background

Timely reperfusion is a major determinant of outcome in acute ischemic stroke. Prehospital emergency medical services (EMS) may facilitate faster hospital access and earlier treatment initiation, thereby influencing survival.

Objectives

To evaluate the association between EMS utilization, treatment delays, and in-hospital mortality among patients with acute ischemic stroke receiving reperfusion therapy, and to explore whether the mode of hospital arrival is associated with outcomes beyond treatment timing.

Materials and methods

This retrospective observational cohort study included adult patients who underwent reperfusion therapy at a tertiary center between January and December 2024. Patients were categorized according to mode of arrival (EMS vs. non-EMS). Treatment time metrics, reperfusion modality, length of hospital stay, and in-hospital mortality were compared. Multivariable logistic regression analysis was performed to identify independent predictors of mortality.

Results

A total of 251 patients were analyzed, 67.0% of whom arrived via EMS. Patients transported by EMS had significantly shorter median onset-to-treatment times (150 vs. 254 min; p < 0.001) and door-to-treatment times (69 vs. 134 min; p < 0.001). In-hospital mortality was significantly lower in the EMS group (17.3% vs. 59.5%; p < 0.001). In multivariable analysis, increasing treatment delay (odds ratio [OR]: 1.016), older age, and baseline stroke severity were independent predictors of mortality.

Conclusion

Utilization of EMS was associated with shorter treatment delays and lower in-hospital mortality among patients receiving reperfusion therapy. These findings suggest that, beyond reducing delays, EMS use may reflect more efficient stroke care pathways that contribute to improved clinical outcomes.

Graphic abstract