Factors Associated With the Hospital Arrival Time in Patients With Ischemic Stroke in Korea

Sim, Jeongha; Shin, Cha-Nam; An, Kyungeh; Todd, Michael

doi:10.1097/jcn.0000000000000313

Cited by 13 publications

(11 citation statements)

References 20 publications

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“…The patients’ perception of symptom severity and prior stroke knowledge directly affected decision delay and indirectly affected prehospital delay in this study. The findings from previous studies also reported consistent relationships between patients perceiving their symptoms as severe and immediate treatment-seeking decisions (Iversen et al, 2020; Sim et al, 2016). The influence of stroke knowledge on delay times is still debated because some researchers measured knowledge of stroke using a single question (Faiz et al, 2014; Geffner et al, 2012; Iversen et al, 2020).…”

Section: Discussionsupporting

confidence: 73%

“…Prehospital treatment-seeking delay is defined as the time from symptom onset to hospital arrival (Powers et al, 2019). Some investigators (Keskin et al, 2005; Sim et al, 2016) have divided prehospital delay into patient/bystander decision delay (the time between stroke symptom onset and a decision to seek treatment) and transportation delay (the time between a decision to seek treatment and hospital arrival). However, the definition of symptom onset varies, especially if the patient awoke with stroke symptoms (Faiz et al, 2014; Keskin et al, 2005).…”

Section: Treatment-seeking Decision After Stroke Symptomsmentioning

confidence: 99%

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Decision Delay Is a Significant Contributor to Prehospital Delay for Stroke Symptoms

et al. 2022

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Prehospital delay after stroke symptom onset is a primary barrier to eligibility for reperfusion therapies. Decision delay is an understudied contributor to prehospital delay. We aimed to explore decision delay as a component of prehospital delay. For this correlational study, 170 Thai acute stroke patients were interviewed to explore their treatment-seeking decision factors: prior stroke knowledge, onset context, and cognitive, emotional, and behavioral factors. Participants’ mean age was 61.2 years, and 46% were women. Median decision delay and prehospital delay times were 120 and 372 minutes. Decision delay represented 49% of prehospital delays. Factors shortening decision delay were atrial fibrillation, prior stroke knowledge, perceived cause of symptoms as stroke, perceived severity of symptoms, and advice from bystanders to seek treatment. In contrast, seeking support from others and self-treatment affected prolonged decision delay. Shortening decision delay, often under the patient or bystander control, can reduce overall prehospital delay.

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Section: Discussionsupporting

confidence: 73%

Section: Treatment-seeking Decision After Stroke Symptomsmentioning

confidence: 99%

Decision Delay Is a Significant Contributor to Prehospital Delay for Stroke Symptoms

et al. 2022

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“…The interval between the onset of symptoms and the arrival at the hospital greatly influences the treatment efficacy and the final prognosis of the patient [10]. Most of the studies on prehospital delay (PHD) have focused on the identification of the socio-demographic, clinical, and contextual characteristics of patients who choose not to seek immediate treatment [11,12,13,14]. However, the PHD can also be affected by other behavioral and cognitive factors and features that have hardly been studied [15].…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Shortening of Prehospital Delay among Patients with Acute Ischemic Stroke

Soto-Cámara

González‐Santos

González-Bernal

et al. 2019

JCM

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Background: Despite recent advances in acute stroke care, only 1–8% of patients can receive reperfusion therapies, mainly because of prehospital delay (PHD). Objective: This study aimed to identify factors associated with PHD from the onset of acute stroke symptoms until arrival at the hospital. Methods: A cross-sectional study was conducted including all patients consecutively admitted with stroke symptoms to Burgos University Hospital (Burgos, Spain). Socio-demographic, clinical, behavioral, cognitive, and contextualized characteristics were recorded, and their possible associations with PHD were studied using univariate and multivariable regression analyses. Results: The median PHD of 322 patients was 138.50 min. The following factors decreased the PHD and time until reperfusion treatment where applicable: asking for help immediately after the onset of symptoms (OR 10.36; 95% confidence interval (CI) 4.47–23.99), onset of stroke during the daytime (OR 7.73; 95% CI 3.09–19.34) and the weekend (OR 2.64; 95% CI 1.19–5.85), occurrence of stroke outside the home (OR 7.09; 95% CI 1.97–25.55), using a prenotification system (OR 6.46; 95% CI 1.71–8.39), patient’s perception of being unable to control symptoms without assistance (OR 5.14; 95% CI 2.60–10.16), previous knowledge of stroke as a medical emergency (OR 3.20; 95% CI 1.38–7.40), call to emergency medical services as the first medical contact (OR 2.77; 95% CI 1.32–5.88), speech/language difficulties experienced by the patient (OR 2.21; 95% CI 1.16–4.36), and the identification of stroke symptoms by the patient (OR 1.98; 95% CI 1.03–3.82). Conclusions: The interval between the onset of symptoms and arrival at the hospital depends on certain contextual, cognitive, and behavioral factors, all of which should be considered when planning future public awareness campaigns.

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“…Among 233 patients who were enrolled in a large-scale study, 160 patients who had arrived at the hospital within 72 h after symptom onset were included in the data analysis. Details about the large-scale study are reported elsewhere [35]. Briefly, the inclusion criteria of the 233 patients were as follows: diagnosed with nontraumatic AIS by brain-computed tomography or magnetic resonance imaging; had been admitted to the hospital for at least one month; and had no severe cognitive impairment or communication difficulties, as determined by neurologists at the hospital.…”

Section: Methodsmentioning

confidence: 99%

Facilitators of and barriers to emergency medical service use by acute ischemic stroke patients: A retrospective survey

Shin

Sim

2017

International Journal of Nursing Sciences

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Objective The objective of the study was to identify facilitators and barriers to emergency medical service use among acute ischemic stroke patients in Korea. Methods This paper presents a secondary analysis of a retrospective survey that collected data from questionnaires and medical records. Among 233 acute ischemic stroke patients enrolled in a large-scale study, 160 patients who had arrived at a hospital within 72 h after symptom onset were included in the data analysis. Results Users of emergency medical services needed a shorter time than non-users to arrive at hospital (140 min vs. 625 min., p = 0.001) and were more likely to arrive at hospital within 3 h of symptom onset (51.9% vs. 31.5%, p = 0.013). For those who first contacted emergency medical service, the facilitators of emergency medical service use were the presence of hemiparesis ( p = 0.003), bilateral paralysis ( p = 0.040), and loss of balance ( p = 0.021). The predominant barrier was the failure to recognize the urgency of symptoms ( p = 0.006). Conclusions The use of emergency medical services reduced prehospital delay and increased the likelihood of patient arrival at hospital within 3 h. Given that experiencing typical stroke symptoms was a facilitator of emergency medical service use yet failure to recognize the urgency of symptoms was a barrier, public awareness should be raised as regards stroke symptoms and the benefits of using emergency medical services.

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Factors Associated With the Hospital Arrival Time in Patients With Ischemic Stroke in Korea

Abstract: Nationwide efforts are needed to promote public awareness of stroke and to develop strategies to reduce prehospital delay time for ischemic stroke patients, particularly those who reside in rural areas in Korea.

Cited by 13 publications

References 20 publications

Decision Delay Is a Significant Contributor to Prehospital Delay for Stroke Symptoms

Decision Delay Is a Significant Contributor to Prehospital Delay for Stroke Symptoms

Factors Associated with Shortening of Prehospital Delay among Patients with Acute Ischemic Stroke

Facilitators of and barriers to emergency medical service use by acute ischemic stroke patients: A retrospective survey

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