Status of emergency medical service use for acute ischemic stroke in China

The current status of emergency medical service (EMS) use among patients with acute ischemic stroke (AIS) in China is a concern. We aimed to understand the status of EMS use and influencing factors in patients with AIS in China. In this large-scale prospective multicenter hospital-based registry study, we evaluated the data of 10,856 patients with AIS admitted to 21 hospitals across different economic and geographic regions in China in 2022. The primary outcome was the proportion of patients arriving at the hospital via EMS. In patients with AIS who arrived independently and those who arrived via EMS, 79.9% and 47.1%, respectively, had an onset-to-door time > 3 h; 16.0% and 40.6%, respectively, received intravenous thrombolysis; and 4.0% and 15.5%, respectively, underwent thrombectomy. Factors promoting EMS use included older age, residence in a small city, wake-up stroke, cardioembolic stroke, and National Institutes of Health Stroke Scale scores 5–15 and 16–42 after onset. Conversely, small-artery occlusion was associated with patients arriving to hospital independently. Hospital arrival via EMS significantly reduced prehospital delay and increased thrombolysis rate compared to arriving at the hospital independently. Improving public education regarding the advantages of using EMS is needed.