Factors delaying hospital admission in acute stroke

Jørgensen, Henrik; Nakayama, Hirofumi; Reith, Jakob; Raaschou, Hans Otto; Olsen, Tom Skyhøj

doi:10.1212/wnl.47.2.383

Cited by 146 publications

(154 citation statements)

References 7 publications

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“…13,16 Many reasons were accountable for this concerning prehospital delay: inability to recognize stroke signs and symptoms by patients or their families, a wait-and-see attitude, and unwilling to call emergency medical services unless the stroke is severe. 17 In the CNSR, more than half of the patients with AIS (54.1%) arrived at the ED by taxi, and less than 1 in 5 (18.9%) used emergency medical services. For those who arrived at the ED quicker, they were likely to be treated.…”

Section: Discussionmentioning

confidence: 99%

Using Recombinant Tissue Plasminogen Activator to Treat Acute Ischemic Stroke in China

Wang

Liao²,

Wang³

et al. 2011

Stroke

203

111

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on behalf of the China National Stroke Registry (CNSR) InvestigatorsBackground and Purpose-Little is known about intravenous recombinant tissue plasminogen activator (rtPA) use in China. By accessing the Chinese National Stroke Registry (CNSR), the rate of intravenous rtPA use was reviewed. We specifically examined the issues of prehospital and in-emergency department delay and compared them with the published data from developed countries. Methods-Funded by Chinese government, CNSR is the only nationwide stroke registry that includes 132 urban hospitals.All patients eligible for intravenous rtPA were included for analysis. We then compared the onset-to-needle time and door-to-needle time in the emergency department in China with those in developed countries. Key Words: registries Ⅲ stroke Ⅲ thrombolytic therapy S troke is the second leading cause of death after cancer in the world. 1 However, stroke has become the leading cause of death among all diseases in China, which has one fifth of the total population in the world. Currently, Ͼ7 million Chinese have strokes, and approximately 65% of them are ischemic. Rising incidence and morbidity of stroke have created a heavy burden to the Chinese healthcare system. 2-4 Since its approval in the United States in 1996, intravenous recombinant tissue plasminogen activator (rtPA) has been used in treating acute ischemic stroke (AIS) for Ͼ15 years in developed countries. 5 With the reported rate of using rtPA between 1.2% and 9%, 6 -8 their experiences have identified many barriers of giving rtPA such as prehospital or in-hospital delay, short treatment time window, and lack of hospital infrastructure and readiness. Delay in presentation is the most common reason for exclusion. Many studies found that only approximately 20% to 25% of patients with acute stroke arrived in the hospital within 3 hours. 6 Results-From Case Enrollment and Target Population Data Collection and ManagementAll research coordinators and study investigators were trained and certified to assess National Institutes of Health Stroke Scale (NIHSS) scores and modified Rankin Scale before the beginning of the trial. Trained research coordinators at each site reviewed medical records daily and identified, consented, and enrolled all eligible patients. A paper-based registry form developed by the advisory panel was used for data collection. Information collected included patient demographics, use of emergency medical services, the time of symptom onset and arrival at the ED, initial brain imaging, NIHSS scores, prestroke modified Rankin Scale, medical history, diagnosis, stroke management, and discharge status. Type of thrombolytics and doses, intravenous (IV), intra-arterial (IA), or IV and IA combination, treatment time, and reasons for not giving thrombolytic therapies were also recorded.At each site, all data elements from each paper-based registry form were manually checked for completeness, correct coding, and proper application of diagnostic algorithm by a research specialist who had experience in c...

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Section: Discussionmentioning

confidence: 99%

Using Recombinant Tissue Plasminogen Activator to Treat Acute Ischemic Stroke in China

Wang

Liao²,

Wang³

et al. 2011

Stroke

203

111

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“…Revela o baixo nível de conhecimento populacional a respeito do AVC, resultando em demora por busca de atendimento médico 28,29,30 . Os principais motivos identificados pelos estudos são: paciente ou familiar não reconheceu sintomas 30,31,32,33,34,35 , ou não buscou por ajuda 28,36,37 e paciente ou familiar não acionou o serviço pré-hospitalar 20,28,31,36,38 .…”

Section: Barreiras Externas • Fatores Relacionados Aos Pacientesunclassified

Análise das barreiras à utilização de trombolíticos em casos de acidente vascular cerebral isquêmico em um hospital privado do Rio de Janeiro, Brasil

et al. 2013

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O acidente vascular cerebral isquêmico (AVCi) é uma importante causa de sequela e morte. A correta utilização do trombolítico enfrenta várias barreiras. O objetivo foi discutir as barreiras à terapia trombolítica em pacientes que chegam, com sintomas de AVCi agudo, à emergência de um hospital privado do Rio de Janeiro, Brasil. Coorte retrospectiva de pacientes entre 2009 e 2011. Foram admitidos 257 pacientes com suspeita de AVCi. Dos pacientes com diagnóstico confirmado (156), 11,5% (18) foram trombolisados. Dos 30 pacientes com diagnóstico de AVCi, dentro da janela terapêutica e com NIHSS na faixa para trombólise, 20 não foram trombolisados, 9 por barreiras administrativas (45%). Neste trabalho o percentual de trombólise foi superior ao observado nos Estados Unidos, mas barreiras impediram o tratamento de 45% dos pacientes com indicação à trombólise. Imagina-se que na rede pública brasileira a situação seja ainda mais desfavorável.

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“…Fakat ne yazık ki birçok hasta bu süre içerisinde acil serviste olamamaktadır. Literatürdeki çalışmalarda inme hastalarının ilk 3 saat içerisinde hastaneye başvurma oranı %21 ile %48 arasında değişmektedir (15,(32)(33)(34)(35) . Bu oran çalışmamızda %20.5 olarak saptandı.…”

Section: Materyal Metodunclassified

“…(32) çalışmasında 553 inme hastasının %32'sinin ilk 1.5 saatte, %48'inin ilk 3 saat içinde, Jorgensen ve ark. (33) ' nın Avustralya'da yaptıkları 1008 hastayı içeren çalışmalarında hastaların %21' inin (n=216) ilk 1 saat içinde, %52' sinin (n=529) ilk 4 saatte, sık rastlanan fizik muayene anormalliği hipertansiyondur. Hastalar acil servise geç başvurmaktadır.…”

Section: Materyal Metodunclassified

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

Kıyan¹,

Ozsarac²,

Ersel³

et al. 2009

jaem

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AIM:We aimed to intend to contribute to our countries database for acute stroke patients with identifying etiological, epidemiological, demographic and clinical features of those patients. METHODS:This is a retrospective descriptive study. Patients' charts are identified with help of ICD-10 coding system. 124 patients were enrolled to the study. RESULTS:Patients in male gender were 56.5 % (n: 70) and mean age of the study group was 67.5 ± 11.8. Average time of the onset of the symptoms was found to be 13.0 ± 18.5 hours. Only twenty five patients (20.5 %) were attended to the emergency department (ED) with in the there hours of symptoms onset.In patients past medical history, 58.8 % (n: 73) patients are hypertensive, 35.0 % (n: 43) are diabetic, 25.0 % (n: 31) of them have coronary artery disease, 20.1 % (n: 25) have a previously known stroke attack.Hundred patients (80.6 %) have a normal head CT. Mortality and morbidity rate was found to be 0.8 % and 6.5 % respectively in patients who were observed in the ED. Average observation time in the ED was 21.5 ± 30.5 hours (1-168). Fifty one patients (41.1 %) were admitted to intensive care unit and six patients were admitted to the neurology ward. CONCLUSION:Acute ischemic stroke is common in old male patients. Most important risk factors are hypertension and diabetes. Patients mostly attend to the hospitals lately. Observation periods of those patients are very long in the ED.

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Factors delaying hospital admission in acute stroke

Cited by 146 publications

References 7 publications

Using Recombinant Tissue Plasminogen Activator to Treat Acute Ischemic Stroke in China

Using Recombinant Tissue Plasminogen Activator to Treat Acute Ischemic Stroke in China

Análise das barreiras à utilização de trombolíticos em casos de acidente vascular cerebral isquêmico em um hospital privado do Rio de Janeiro, Brasil

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

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