Factors Delaying Hospital Arrival Aftr Acute Stroke Onset

Abstract

Introduction: Optimal time of referral after stroke and the use of new therapies, such as r-tPA and blood pressure control, could accelerate symptoms recovery after stroke. The aim of this study was to investigate factors contributing to the delay in referral to hospitals after the occurrence of acute stroke. Methods: This analytic-descriptive study included 425 patients, who had referred to the Hamadan Farshchian hospital during years 2015 and 2016. Demographic data, time of referring to medical center, the time of occurrence of stroke, risk factors, clinical symptoms of stroke, way of referring, distance from medical center and type of stroke by using a questionnaire and checklist were recorded. The SPSS (version 16) software was used for all calculations. Results: The mean age of patients in this study was 70.12 years old. Overall, 260 patients (61.2%) were male and 85.6% had ischemic stroke. Mean time of referral to first treatment center and Farshchian hospital was 2.06 and 4.77 hours, respectively. A total of 36.2% patients arrived to Farshchian hospital, within less than 2 hours. Factors that prolonged time to presentation were male gender, ischemic stroke, low education, being at a location far from the medical center, referral from other medical centers, being single, having no witness during stroke, and having a stroke at home, and during night. The most common symptoms in patients who were referred within less than two hours were confusion and loss of consciousness with frequency of 29.2%. The most common risk factor in 61.4% of patients, who were referred within less than 2 hours, was high blood pressure. Conclusion: This study showed mean time of referral for treatment after stroke was high. Influential elements that could possibly delay hospital arrival include, being at a location far from the medical center, no adequate knowledge about stroke symptom, having stroke at night, not referring directly to the medical center, being single, and no witness during stroke.

Factors affecting pre-hospital and in-hospital delays at time-to-treatment and complications in stroke: A prospective cohort study

“…In the study of Ghiasian et al in Hamadan, Iran, the time of symptoms initiation to arrival to the hospital was 282 minutes and it was 192 minutes in the study of Griesser et al (24,25), which is close to our results. However, it was 916 minutes in the study of Ayromlou et al, in Tabriz, Iran, which is inconsistent with our study (20).…”

“…In line with our study, the results of studies performed in Europe, America, and Asia indicated that lack of awareness of stroke symptoms, patients' misconceptions and beliefs regarding the primary symptoms, and failure to consult a person after the onset of the symptoms led to further delay in arrival to the hospital and time-to-treatment for stroke patients (22,24,(26)(27)(28)(29)(31)(32)(33). The ndings suggest that consulting with others following the onset of symptoms may be effective in preventing a delay in cases the patient's symptoms are not well recognized or taken seriously.…”

Factors Influencing Pre-Hospital and In-Hospital Delays at Time-To-Treatment and Complications in Stroke: A Prospective Cohort Study

“…Along with our study, Ghiasian et al in a study in Hamadan (Iran) reported that the time of symptoms onset to arrival to the hospital was 282 minutes, while it was 192 minutes in the study of Griesser et al (24,25). Nevertheless, in the study of Ayromlou et al in Tabriz (Iran), this time was 916 minutes, which is not in line with our results (20).…”

Effect of Public Education Regarding Stroke Warning Signs on Pre-Hospital Delay and Frequency of Tissue Plasminogen Activator Therapy in Stroke Patients: A Quasi-Experimental Study

“…However, according to the results of a study by Raty et al, only 5.6% of the patients were referred to the clinics at the desired time (17). In Iran, according to study by Ghiasian et al, the mean delay time was 7.4 hours (18).…”

“…In this regard, various global studies have been conducted with an educational approach to raise the level of awareness of the community about the warning signs of stroke and the need for early referral of patients after the onset of symptoms (19)(20)(21)(22)(23)(24). In Iran, only few descriptive relevant studies have been conducted to address the causes of delay (18,25), and also no interventional study to increase the public awareness was found. Therefore, this study was conducted due to the importance of this subject and limited relevant studies.…”