Factors delaying management of acute stroke: An Indian scenario

Abstract

Background and Purpose:The purpose of this study was to assess factors causing delay in treatment of acute stroke in a tertiary care institute in South India.Methods:All clinically suspected cases of acute stroke presenting to the emergency department over a period of 1 year were prospectively followed up and data collected as per a preset pro forma. The various time intervals from stroke onset to definitive management and other pertinent data were collected. The time delays have been evaluated in the decision tree model: Chi-squared Automatic Interaction Detection. Significance was assessed at 5% level of significance (P < 0.05).Results:The mean prehospital time delay for all clinically suspected stroke (n = 361) in our institute was 716 min and the median time 190 min. The mean total in-hospital delay was 94.17 ± 54.5 min and median time being 82 min. The onset of symptoms to first medical contact was the main interval that influenced the prehospital delay. Computed tomographic (CT) diagnosis to stroke unit admission influenced the in-hospital delay the most.Conclusions:Lack of awareness regarding stroke leads to delayed seeking of treatment for the same. The factors that contribute to the in-hospital delay included patient admission procedure delay, lack of staff to transport the patient, and the distance between the stroke unit and CT room. Educating the community with regard to “stroke” and implementation of a better pre- and in-hospital stroke care system is a need of the hour in the country.

A Study of the Pattern of Admissions to the Accident and Emergency (A&E) Department of a Tertiary Care Hospital in Sri Lanka

“…This may be explained by the unavailability of ambulances and a lack of awareness in people about thrombolysis which needs further studies for clarification. In Kerala, India (which is the most literate state in the country), 84% were unaware of symptoms and signs of stroke [ 13 ]. There was a reasonable number of major dog bites.…”

Factores asociados a llegada y evaluación precoz de pacientes con ataque cerebrovascular en un hospital regional de alta complejidad

“…A su vez, un 21,8% de los sujetos consultó dentro de 3 h desde el inicio de los síntomas. El tiempo de llegada o prehospitalario en ACV agudo puede verse influidos por múltiples factores: geográficos, demográficos, educacionales, socioeconómicos y organizacionales 26 . En nuestra investigación encontramos que tener domicilio en Temuco-Padre Las Casas, el origen urbano, la llegada por propios medios y la severidad del ACV (NIHSS ≥ 7), se asociaron a un tiempo de llegada menor a 3 h.…”

Pre- and In-Hospital Management of Stroke

“…However, in a Greek study, 24% of the study participants surveyed did not know any stroke symptoms [35]; in Spain, 11% did not know any symptoms [36]; in the United States, 32% did not know any symptoms [27], and in Hubei Province in China, around 60% of patients did not recognize initial stroke symptoms [37]. Even in family physicians and non-neurologists, this phenomenon also exists [16,[38][39][40][41].…”