Partnering With an Urban Hospital for Stroke Preparedness in the Emergency Department: SPEDI Randomized Controlled Trial.

Abstract

We tested the Stroke Preparedness in the Emergency Department Intervention, an emergency department-based intervention that teaches stroke symptoms and the importance of calling 911, in a racially diverse community. This was a National Institutes of Health-funded, single-center, participant-blinded parallel-group trial of adult emergency department patients randomized 1:1 to a brief pamphlet and video stroke preparedness intervention versus a general cardiovascular health control condition (Life's Simple 7; from February 2022 to August 2023). The primary outcome was intent to call 911 in response to 4 video vignettes (Video STAT instrument) depicting an actor having an acute stroke (stroke action score, range 0-8) at 1 month (delayed posttest). Secondary outcomes were recognition of the 4 videos depicting an acute stroke (stroke recognition score; range, 0-4) and the stroke action score immediately after treatment. Linear mixed models evaluated the association between intervention groups and each outcome, with adjustment for baseline characteristics, in a prespecified per-protocol analysis. Of the 353 participants randomized, 330 participants were included (159 in the intervention group, 171 in the control group, 61% female, 49% Black adults). The intervention group had a higher intent to call 911 than the control group on the immediate posttest (adjusted mean stroke action score difference, 1.14 points higher [95% CI, 0.78-1.50]; <i>P</i><0.001) and on the delayed posttest (1.12 points higher [95% CI, 0.64-1.59]; <i>P</i><0.001). The intervention group had higher stroke recognition than the control group on the immediate posttest (adjusted mean stroke recognition score difference, 0.40 points higher [95% CI, 0.23-0.56]; <i>P</i><0.001) and on the delayed posttest (0.51 points higher [95% CI, 0.30-0.72]; <i>P</i><0.001). Treatment effects did not differ by sex or race (<i>P</i>>0.05). Among an adult emergency department population, a brief intervention increased intent to call 911 for stroke and increased recognition of stroke symptoms.