Emergency perception and other variables associated with extra‐hospital delay in stroke patients in the Maresme region (Spain)

Abstract

Delay in arrival to the emergency room (ER) may negatively influence outcome of stroke patients. We aim to analyze factors that influence extra-hospital delay in stroke patients. Two hundred and ninety-two consecutive stroke patients admitted in the ER were prospectively studied. Analysis was made to identify variables associated with <1- and <3 h delays from onset. About 18.8% of patients arrived before 1 h and 57.5% before 3 h. Factors independently associated with <3 h delay were decision to go immediately to ER (OR = 8.17; 95% IC = 4.47-18.8), ambulance transportation (OR = 2.35; 1.36-4.05) and total anterior circulation syndrome (TACS) (OR = 3.74; 1.51-9.24). History of >1 vascular risk factor was associated with a greater delay (OR = 0.47; 0.26-0.86). Factors associated with a <1 h delay were: (i) immediate decision to attend the ER (OR = 3.55; 1.85-6.81), (ii) stroke on Sunday (OR = 3.46; 1.56-7.66), (iii) aphasia (OR = 2.41; 1.23-4.74), (iv) absence of stairs at home (OR = 0.37; 0.17-0.81) and (v) absence of diabetes mellitus (OR = 0.42; 0.20-0.88). In our area, nearly 60% of stroke patients arrive to ER before 3 h from onset. Immediate decision to attend the ER has the strongest association with a short delay. Patients with TACS arrived mainly before 3 h and those with isolated aphasia arrived before 1 h. Patients with vascular risk factors attended the hospital later. Ambulance transportation is associated with <3 h delay, but not with <1 h.

Time to Hospital Admission and Start of Treatment in Patients with Ischemic Stroke in Northern Italy and Predictors of Delay

“…However, with reference to the pre-hospital times, 64.0% of cases arrived within 3 h, 73.1% within 4.5 h, and 78.2% within 6 h. Others found fairly similar percentages at 3 h (51.1-57.5%) [20,21,22] and 6 h (66.4-81.0%) [20,21,22,23]. …”

“…Although timing of thrombolysis has been reported in several current guidelines, long time intervals between onset of symptoms, emergency department (ED) admission and initial treatment are still major limitations. Several studies [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38] have evaluated these times to identify factors leading to pre-hospital and in-hospital delays. A previous Italian study [10] analyzed factors influencing time to hospital arrival, but few studies are available with regard to in-hospital delay.…”

Factors Influencing Pre-Hospital Delay after Ischemic Stroke and Transient Ischemic Attack

“…However, few studies have investigated the causes of pre-hospital delay within this 2-hour window (4,5). The relationship between pre-hospital delay and some factors also remains unknown: the time period between stroke onset and contacting Emergency, or distance that patient is transported (6)(7)(8)(9).…”

Reducing prehospital delay in acute stroke

“…reports indicate that the proportion of patients with acute stroke arriving at the emergency department within 1 h of stroke onset is ≤18.8%, with the proportion of individuals arriving within 3 h ranging from 8% to 58%. 6,[12][13][14][15] inhospital delay can occur during the following phases: from arrival at the emergency department to the first medical or neuro logical assessment; from the first medical or neuro logical assess ment to neuro imaging; from neuroimaging to obtaining informed consent to start thrombolysis; and from the start of thrombolysis to the administration of alteplase. 16,17 in this article, we review the problem of prehospital delay in stroke.…”