Prehospital and In-Hospital Delays in Acute Stroke Care

Abstract

Current guidelines emphasize the need for early stroke care. However, significant delays occur during both the prehospital and in-hospital phases of care, making many patients ineligible for stroke therapies. The purpose of this study was to systematically review and summarize the existing scientific literature reporting prehospital and in-hospital stroke delay times in order to assist future delivery of effective interventions to reduce delay time and to raise several key issues which future studies should consider. A comprehensive search was performed to find all published journal articles which reported on the prehospital or in-hospital delay time for stroke, including intervention studies. Since 1981, at least 48 unique reports of prehospital delay time for patients with stroke, transient ischemic attack, or stroke-like symptoms were published from 17 different countries. In the majority of studies which reported median delay times, the median time from symptom onset to arrival in the emergency department was between 3 and 6 h. The in-hospital times from emergency department arrival to being seen by an emergency department physician, initiation and interpretation of a computed tomography (CT) scan, and being seen by a neurologist were consistently longer than recommended. However, prehospital delay comprised the majority of time from symptom onset to potential treatment. Definitions and methodologies differed across studies, making direct comparisons difficult. This review suggests that the majority of stroke patients are unlikely to arrive at the emergency department and receive a diagnostic evaluation in under 3 h. Further studies of stroke delay and corresponding interventions are needed, with careful attention to definitions and methodologies.

Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital

“…Although several studies have reported on means of improving the timeliness of thrombolysis in acute stroke, [14][15][16][17][18]25 none has specifically focused on public safety net hospitals, which generally have less funding and treat more underor uninsured patients. As one of these hospitals, our institution treats a diverse and relatively socioeconomically disadvantaged population.…”

“…12,13 Despite the clear benefits of early thrombolysis, delays in stroke recognition, hospital arrival, emergency department (ED) triage, imaging, neurology consultation, and treatment preparation and delivery impede the achievement of recommended door-to-needle (DTN) times of less than 60 minutes. 14,15 Accordingly, there exists substantial interest in targeted, effective interventions to reduce these times. Numerous studies have examined various targeted interventions to this end, including a systematic quality improvement study conducted as part of the original National Institutes of Neurologic Disorders and Stroke-sponsored trial showing benefit with tPA.…”

Death and survival of neuronal and astrocytic cells in ischemic brain injury: a role of autophagy

“…However, the excitotoxic phase mediated by the release of excitatory acids into the brain peaks within 1 to 2 h after ischemia, and treatments with anti-excitotoxic drugs are only effective when given within 1 to 2 h after focal ischemia in animal models [80] . Considering that the median hospital arrival time for stroke patients is 3 to 6 h [81] and all of the trials of antiexcitotoxic drugs have been used to treat patients up to at least 6 h after the onset of symptoms, the negative outcomes of the 35 completed trials of antiexcitotoxic agents are not surprising. In the development of new therapies, focus must be placed on targets producing long-lasting protection and efficacy even when treatments are given during or at the 4 to 6 h after symptom onset, which is when patients generally arrive at the hospital.…”

Acil Servise Başvuran Akut İskemik İnmeli 124 Hastanın Geriye Yönelik Bir Yıllık İncelenmesi

“…(35) ' nın İtalya'da yaptıkları 189 hastalık çalışmada hastaların %31'inin ilk 2 saat içinde başvurdukları görülmektedir. Akut inme tedavisinin başlamasındaki gecikme değişik aşamalarda gelişmektedir fakat en büyük zaman dilimi hastane dışında yitirilmektedir (36) . Ferro ve ark.…”