A retrospective analysis of time delays in patients presenting with stroke to an academic emergency department

Abstract

BackgroundStroke presents commonly to the emergency department (ED), and is a common cause of morbidity and mortality in South Africa. Early ED presentation and early neuroimaging are required in order for thrombolysis to be a potential therapeutic modality.ObjectivesTo determine the time to ED presentation, time to computed tomography (CT) scan and the potential influencing factors for patients with stroke.MethodsA retrospective record review of all patients who presented with clinical features of stroke to a tertiary academic ED in Johannesburg, South Africa, from 01 January to 31 December 2014.ResultsData from 232 eligible stroke patients were analysed. The median time to presentation to the ED was 33 h with the majority of patients (81.3%) presenting after the 4.5 h window for thrombolysis. The median time to CT was 8 h. Only 3.9% of patients had a CT scan within one hour of arrival. Patients with loss of consciousness were associated with earlier hospital presentation (p = 0.001). None of the patients were thrombolysed.ConclusionPatients with stroke commonly present late to hospital. If we are to make a difference in this group of vulnerable patients, further education and training needs to be emphasised regarding ‘time is brain’. Communication and commitment is also required by the emergency medical services, ED and radiology staff in order to prioritise stroke patients and to reduce delays.

Access to acute care resources in various income settings to treat new-onset stroke: A survey of acute care providers

“…In LMICs, pre-hospital service and national emergency numbers were lacking and in-hospital, significantly less access to specialist neurology and radiology services were reported. These findings fit with known reported delays in presentation and diagnosis [7] , [8] . It is most likely also what contributes to the reported poor outcome [9] , [10] , [11] .…”

Acute stroke in the emergency department: A chart review at KwaZulu-Natal hospital

“…This is comparable to a similar study conducted at a tertiary hospital ED in Johannesburg which saw approximately 60 000 patients per annum and included 0.39% of their patients. 11 Most of the patients (n = 107, 78.68%) presenting with stroke were above 50 years old. This is similar to international trends.…”

A descriptive study of inpatient admissions for cerebrovascular disease at a tertiary hospital in KwaZulu-Natal, South Africa

“…Patient-related delays in presenting to a hospital following a CVD event can impact the effectiveness of current treatments or the eligibility of patients for these treatments. (8,15) A recent study conducted at the Our study was not without limitations. We analysed patient data collected at a single tertiary hospital, and our findings might not be generalisable to other hospitals in South Africa.…”

“…A description of our study sample is provided in (15) Unsurprisingly, clinical outcomes are far worse in patients who delay seeking healthcare for CVD when compared with patients who timeously present to a healthcare facility.…”

“…While it might not be the only reason for patient-related delays in seeking healthcare for CVD, poor knowledge and awareness of this condition in the general population is by far the most commonly cited reason. (15) There is poor knowledge and awareness of cardiovascular conditions, including heart disease and CVD, among the general South African population. (16) A clear understanding of CVD signs and symptoms would enable the condition to be recognised by afflicted patients or their families at an early stage.…”