Factors Associated With Delayed Admission to Hospital and In-Hospital Delays> in Acute Stroke and TIA

Abstract

Background and Purpose-Early admission to hospital followed by correct diagnosis with minimum delay is a prerequisite for successful intervention in acute stroke. This study aimed at clarifying in detail the factors related to these delays. Methods-This was a prospective, multicenter, consecutive study that explored factors influencing the time from stroke or transient ischemic attack (TIA) onset until patient arrival at the emergency department, stroke unit, and CT laboratory. Within 3 days of hospital admission, the patients and/or their relatives were interviewed by use of a standardized structured protocol, and the patients' neurological deficits were assessed. No information about this study was given to the public or to the staff. Results-Patients (nϭ329) were studied at 15 Swedish academic or community-based hospitals: 252 subjects with brain infarct, 18 with intracerebral hemorrhage, and 59 with TIA. Among stroke and TIA patients, the median times from onset to hospital admission, stroke unit, and CT scan laboratory were 4.8 and 4.0 hours, 8.8 and 7.5 hours, and 22.0 and 17.5 hours, respectively. From multivariate ANOVA with logarithmically transformed time for increasing delay to hospital admission as the dependent variable, a profile of significant risk factors was obtained. This included patients with a brain infarct, gradual onset, mild neurological symptoms, patients who were alone and did not contact anybody when symptoms occurred, patients who lived in a large catchment area, those who did not use ambulance transportation, and those who visited a primary care site. These factors explained 45.3% of the variance in delayed hospital admission. The median time from arrival at the emergency department to arrival at the stroke unit or CT scan laboratory (whichever occurred first) was 2.6 and 2.7 hours in the stroke and TIA groups, respectively. A large catchment area, moderate to mild neurological deficit, and waiting for the physician at the emergency department were all significantly related to in-hospital delay. Conclusions-Increased public awareness of the need to seek medical or other attention promptly after stroke onset, to use an ambulance with direct transportation to the acute-care hospital, and to have more effective in-hospital organization will be required for effective acute treatment options to be available to stroke patients. (Stroke. 1999;30:40-48.)

Stroke Awareness and Knowledge in an Urban New Zealand Population

“…Reduced knowledge and awareness of stroke is associated with delay in obtaining urgent medical attention (40,44,45), which in turn is associated with negative clinical outcomes (4,5). Inability to identify and respond to stroke could delay medical intervention and have far-reaching economic impact on the direct and indirect costs (7,46,47) seeking urgent medical attention in the instance of stroke, it is of concern that a high proportion of respondents were unable to define key symptoms of stroke.…”

Acil Servise Başvuran Akut İskemik İnmeli 124 Hastanın Geriye Yönelik Bir Yıllık İncelenmesi

“…Medikal talebin gecikmesindeki önemli etkenler inme semptomlarının bilinmemesi, ciddiyetinin farkına varılmaması, bunun yanı sıra hastalığın görmezden gelinmesi ve semptomların kendiliğinden düzeleceği beklentisidir (25) . Aynı zamanda yalnız yaşamak, inme olayının evde yaşanmış olması, gece saatlerinde inme görülmesi ve özellikle referans hastanelerinin acil servislerine doğrudan başvurmak yerine sağlık merkezlerine yada aile hekimlerine başvurulması en önemli geç başvuru nedenleri olarak gösterilmiştir (42) .…”

Temporal Variations of Stroke Occurence

“…Comparing our results with other studies, there is a divergence in delay times of admission to hospital. Some of them found time of delay 8.8 hours for ischaemic stroke , other 3 hours (11,12). In Minesota study results showed that half patients arrived within 3 hours of symptom onset, and 90% arrived within 24 hours.…”

“…Previous studies showed differencies in time of delay of admission to hospital for IS, some of them found it was 8.8 hours, other 3 hours and other more than 24 hours (11,12,13).…”