Pre-hospital delay in patients with ischemic stroke in the Fann Teaching Hospital, Dakar, Senegal in 2020

Abstract

Introduction stroke is a cerebrovascular disease. Early reperfusion in neurovascular units can reduce its morbidity and mortality. Even when neurovascular units exist, patients usually arrive late in the emergency department. to the purpose of this study was to determine prehospital delay in patients with acute ischemic stroke and associated factors. Methods we conducted a retrospective cross-sectional study in the neurology department of the Fann University Hospital in Dakar from January 1 s t to June 30 th , 2020. We included patients younger than 80 years seen in the emergency unit for ischemic stroke. The median time to presentation was calculated based on the time of stroke onset and that of arrival at the hospital. Multivariate analysis was used to determine factors associated with prehospital delay. Results a total of 56 patients were enrolled, among whom 58.6% arrived at the hospital in less than 3 hours. Of them, 37.5% presented to a level 3 or 4 hospital first. Less than 34% of our patient presented to a level 2-3 hospital in less than 3 hours. Based on bi- and multivariate analysis, being married (OR = 7.2 [CI à 95%: 1.5 - 35.8]), being a female (OR = 5.5 [CI à 95%: 1.5 - 19.8]) and having stroke during week days (OR = 4.3 [CI à 95%: 1.3-13.9]) were associated with prehospital delay. Conclusion most of our patients arrived late at a level 2 or 3 hospital. Being a married woman increased the risk of late arrival. This study highlights the importance of improving awareness in order to increase the proportion of patients potentially eligible for revascularization.

Stroke signs knowledge and factors delaying acute stroke patients’ hospital arrival in the absence of stroke care systems. A Kinshasa multicenter cross-sectional study

“…This study showed a low rate (13%) of stroke awareness and identi ed 12 factors independently associated with late hospital arrival. This study found a male preponderance in stroke presentation, which is consistent with other African in-hospital-based studies (14,(20)(21)(22)(23)(24)(25)], except for Kenyan (26)] and South African studies, where patients with stroke were predominantly female (27)(28)(29)]. These differences may re ect the combined effect of sex (i.e., biological characteristics, including their genetic, biological, and physiological expression), sex (in the sense of a social concept that includes gender identi cation, expression, roles, and stereotypes for women, men, and sex-diverse people) (30)], and gendered exposures (31)] in different regions.…”

“…The age of the patients was 57.9 ± 13.1 years, similar to those in most previous local studies (21,22,32,33)] and studies in the Middle East and North Africa (34)], but higher than that in a recent Senegalese study (14)], with most of the participants in their 40s. It was lower than that in Kenyan studies where the stroke occurred, on average, in the 70s (26)].…”

“…in the INTERSTROKE study for African countries included in the study (42)] and in other studies in DRC (21,22,43)] and elsewhere (14,26)]. As the incidence of stroke increases in proportion to blood pressure (44)] and the decrease in stroke mortality over the past decade is attributed, at least in part, to aggressive treatment of hypertension ( 45)], hypertension is the leading modi able contributor to stroke, with approximately 52% of all strokes attributable to hypertension (…”

Prehospital delay after acute ischemic stroke among Thai older adults: A cross‐sectional study

“…Findings from this study suggest that Thai older patients experience significant prehospital delay, as only 30% arrived at the hospital within 3 h of first observing stroke symptoms, and there were long intervals between the first stroke symptoms and the initiation of care‐seeking behavior. Findings from this study were similar to those of previous studies showing that prehospital delay in older patients with first‐time ischemic stroke is prolonged considerably (Damon et al, 2022; Fladt et al, 2019; Rakchue & Poonphol, 2019).…”

“…When AIS is diagnosed and treated at an early stage, probabilities of long‐term survival are higher (Lee et al, 2021). Numerous studies have shown that patients delay seeking medical attention for stroke symptoms more than 3 h (Damon et al, 2022; Fladt et al, 2019; Rakchue & Poonphol, 2019). If patients delay seeking hospital care, they will miss the opportunity for effective intervention and increase the likelihood of negative outcomes or even death.…”