Pre-Hospital Delay in Patients with Acute Ischemic Stroke in a Multicenter Stroke Registry: K-PLUS

Nagao, Yoichiro; Nakajima, Makoto; Inatomi, Yuichiro; Ito, Yasuyuki; Kouzaki, Yanosuke; Wada, Keita; Yonehara, Toshiro; Terasaki, Tadashi; Hashimoto, Yoichiro; Ando, Yukio

doi:10.1016/j.jstrokecerebrovasdis.2020.105284

Cited by 15 publications

(17 citation statements)

References 28 publications

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“…Unlike previous studies (Nagao et al, 2020; Teuschl & Brainin, 2010), we examined waiting delay and transportation delay separately due to the influence of environmental factors such as traffic, road conditions, or distance to the ED, that are beyond the patients’ control. In this study, many patients waited to be transported by a relative rather than calling EMS.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…We identified 67 studies addressing pre-hospital organizational factors associated with delay or access to ART ( Appendix A - Table A3 ). Activation of stroke code, pre-hospital notification and use of pre-hospital emergency services [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], mobile stroke units [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], implementation of specific electronic apps to insert and share clinical data with the hospital stuff [ 33 ], use of ambulance [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ], telestroke [ 47 , 48 ], implementation of specific pre-hospital protocols [ 49 , 50 ], education campaigns […”

Section: Resultsmentioning

confidence: 99%

“…Under-recognition or delays in recognition of stroke symptoms are consistently identified as one of the main causes of pre-hospital delays [ 8 , 16 ]. Hence, with no surprise, population campaigns focused on stroke recognition, severity and existence of treatment emerged as a common factor to promote ART [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 20 , 23 , 34 , 36 , 38 , 39 , 40 , 41 , 46 , 48 , 103 , 104 , 105 , 106 , 107 , 108 ]. Sustainable levels of population awareness may only be achieved by continuous education campaigns, probably at least six months each [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Botelho

Rios

Fidalgo

et al. 2022

IJERPH

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Background: After onset of acute ischemic stroke (AIS), there is a limited time window for delivering acute reperfusion therapies (ART) aiming to restore normal brain circulation. Despite its unequivocal benefits, the proportion of AIS patients receiving both types of ART, thrombolysis and thrombectomy, remains very low. The organization of a stroke care pathway is one of the main factors that determine timely access to ART. The knowledge on organizational factors influencing access to ART is sparce. Hence, we sought to systematize the existing data on the type and frequency of pre-hospital and in-hospital organizational factors that determine timely access to ART in patients with AIS. Methodology: Literature review on the frequency and type of organizational factors that determine access to ART after AIS. Pubmed and Scopus databases were the primary source of data. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale. Results: A total of 128 studies were included. The main pre-hospital factors associated with delay or access to ART were medical emergency activation practices, pre-notification routines, ambulance use and existence of local/regional-specific strategies to mitigate the impact of geographic distance between patient locations and Stroke Unit (SU). The most common intra-hospital factors studied were specific location of SU and brain imaging room within the hospital, and the existence and promotion of specific stroke treatment protocols. Most frequent factors associated with increased access ART were periodic public education, promotion of hospital pre-notification and specific pre- and intra-hospital stroke pathways. In specific urban areas, mobile stroke units were found to be valid options to increase timely access to ART. Conclusions: Implementation of different organizational factors and strategies can reduce time delays and increase the number of AIS patients receiving ART, with most of them being replicable in any context, and some in only very specific contexts.

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“…This long time to treatment appears common for acute myocardial infarction in developing countries [38], which is alarming since a delay in receiving pre-hospital care for patients with these conditions can increase hospital mortality [39,40,41]. Patients' lack of awareness of the symptoms can contribute to the delay in accessing pre-hospital and emergency services [42]. To reduce the delay, healthcare providers and policymakers should focus on improving patients' awareness of related symptoms, especially for myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

Emergency services utilization in Jakarta (Indonesia): a cross-sectional study of patients attending hospital emergency departments

Brice

Boutilier

Gärtner

et al. 2022

BMC Health Serv Res

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Background Pre-hospital and emergency services in Indonesia are still developing. Despite recent improvements in the Indonesian healthcare system, issues with the provision of pre-hospital and emergency services persist. The demand for pre-hospital and emergency services has not been the subject of previous research and, therefore, has not been fully understood. Our research explored the utilization of emergency medical services by patients attending hospital emergency departments in Jakarta, Indonesia. Methods The study used a cross-sectional survey design involving five general hospitals (four government-funded and one private). Each patient’s demographic profile, medical conditions, time to treatment, and mode of transport to reach the hospital were analysed using descriptive statistics. Results A total of 1964 (62%) patients were surveyed. The median age of patients was 44 years with an interquartile range (IQR) of 26 to 58 years. Life-threatening conditions such as trauma and cardiovascular disease were found in 8.6 and 6.6% of patients, respectively. The majority of patients with trauma travelled to the hospital using a motorcycle or car (59.8%). An ambulance was used by only 9.3% of all patients and 38% of patients reported that they were not aware of the availability of ambulances. Ambulance response time was longer as compared to other modes of transportation (median: 24 minutes and IQR: 12 to 54 minutes). The longest time to treatment was experienced by patients with neurological disease, with a median time of 120 minutes (IQR: 78 to 270 minutes). Patients who used ambulances incurred higher costs as compared to those patients who did not use ambulances. Conclusion The low utilization of emergency ambulances in Jakarta could be contributed to patients’ lack of awareness of medical symptoms and the existence of ambulance services, and patients’ disinclination to use ambulances due to high costs and long response times. The emergency ambulance services can be improved by increasing population awareness on symptoms that warrant the use of ambulances and reducing the cost burden related to ambulance use.

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Pre-Hospital Delay in Patients with Acute Ischemic Stroke in a Multicenter Stroke Registry: K-PLUS

Cited by 15 publications

References 28 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

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Emergency services utilization in Jakarta (Indonesia): a cross-sectional study of patients attending hospital emergency departments

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