Predictors of Time From Hospital Arrival to Initial Brain-Imaging Among Suspected Stroke Patients

Background and Purpose-Emergency department (ED) crowding occurs when demands for ED care exceed the supply of available resources. Prior studies have shown that ED crowding is associated with a delay in provision of critical ED services, but the impact of ED crowding on acute stroke care has not been extensively studied. Methods-We conducted a retrospective study of patients who presented to the ED with acute stroke symptoms (ischemic stroke, transient ischemic attack, intracerebral hemorrhage) at 2 hospitals. All patients with active stroke symptoms who presented within 3 hours were included and a random sample of patients with symptoms Ͼ3 hours was used for comparison. The association between ED crowding measures (waiting room number, ED occupancy, number of admitted patients, and total patient hours) and time to head CT order, completion, and interpretation, and time to administration of thrombolysis was determined. Results-Of 253 patients presenting with acute stroke symptoms Յ3 hours from symptom onset, 52 (21%) received thrombolysis. A random comparison group of 253 patients with symptoms Ͼ3 hours was identified. There was no significant association between ED crowding and delays in CT timing or thrombolysis in patients with symptoms Յ3 hours. Several measures of ED crowding were associated with prolonged times to CT order and completion in patients with symptoms Ͼ3 hours. Conclusions-ED crowding was not associated with care delays in thrombolysis-eligible patients with stroke. However, those with symptoms Ͼ3 hours do experience CT delays at higher levels of ED crowding.

Section: Discussionmentioning

confidence: 99%

Emergency Department Crowding and Time to Care in Patients With Acute Stroke

Chatterjee

Cucchiara

Lazarciuc

et al. 2011

“…8 A multiple linear regression analysis of 20 374 patients with stroke enrolled in the North Carolina Collaborative Stroke Registry from January 2005 to April 2008 to study predictors of delay time from hospital arrival until CT scan found that among other factors, weekend and evening time arrival were associated with delay in CT scan. 9 A study of 78 657 patients with acute ischemic stroke in the Virginia Patient Data System from January 1, 1998, to June 30, 2006, demonstrated weekend patients were more likely to receive tissue plasminogen activator but had no difference in mortality than their weekday counterparts. 10 Prospective data on 2211 patients with stroke admitted to 2 comprehensive stroke centers were analyzed and showed that weekend patients had no difference in discharge disposition, discharge, or 90-day modified Rankin score or 90-day mortality than weekday patients.…”

Section: Discussionmentioning

confidence: 99%

“…8 In North Carolina, patients with acute ischemic stroke admitted on weekends wait longer to undergo a CT scan. 9 In Virginia, weekend patients with stroke are more likely to receive tissue plasminogen activator, albeit with no improvement in mortality. 10 In a study of 2 comprehensive stroke centers, there was no difference in discharge disposition, discharge, or 90-day modified Rankin score or 90-day mortality between patients with stroke admitted on weekends compared with weekdays.…”

mentioning

confidence: 99%

Effect of Weekend Compared With Weekday Stroke Admission on Thrombolytic Use, In-Hospital Mortality, Discharge Disposition, Hospital Charges, and Length of Stay in the Nationwide Inpatient Sample Database, 2002 to 2007

Hoh

Chi

Waters

et al. 2010

113

“…[21][22][23] A study conducted in 4 Berlin hospitals used proportional hazard models to evaluate door-to-image times among 558 patients with stroke hospitalized in 2000 to 2001. 22 Women had significantly longer median door-to-image times in univariate analyses (120 versus 102 minutes; hazard ratio, 0.83).…”

Section: Discussionmentioning

confidence: 99%

Do Presenting Symptoms Explain Sex Differences in Emergency Department Delays Among Patients With Acute Stroke?

Gargano

Wehner

Reeves

2009

Background and Purpose-Previous studies report that women with stroke may experience longer delays in diagnostic workup than men after arriving at the emergency department. We hypothesized that presenting symptom differences could explain these delays. Methods-Data were collected on 1922 acute stroke cases who presented to 15 hospitals participating in a statewide stroke registry. We evaluated 2 in-hospital time intervals: emergency department arrival to physician examination ("door-todoctor") and emergency department arrival to brain imaging ("door-to-image"). We used parametric survival models to estimate time ratios, which represent the ratio of average times comparing women to men, after adjusting for symptom presentation and other confounders. Results-Women were significantly less likely than men to present with any stroke warning sign or suspected stroke (87.5% versus 91.4%) or to report trouble with walking, balance, or dizziness (9.5% versus 13.7%). Difficulty speaking and loss of consciousness were associated with shorter door-to-doctor times. Weakness, facial droop, difficulty speaking, and loss of consciousness were associated with shorter door-to-image times, whereas difficulty with walking/balance was associated with longer door-to-image times. In adjusted analyses, women had 11% longer door-to-doctor intervals (time ratio, 1.11; 95%, CI 1.02 to 1.22) and 15% longer door-to-image intervals (time ratio, 1.15; 95% CI, 1.08 to 1.25) after accounting for presenting symptoms, age, and other confounders. Furthermore, these sex differences remained evident after restricting to patients who arrived within 6 or within 2 hours of symptom onset. Conclusions-Women with acute stroke experienced greater emergency department delays than men, which were not attributable to differences in presenting symptoms, time of arrival, age, or other confounders.