Stroke education focusing on recognition and response to decrease pre-hospital delay in India: Need of the hour to save hours

Vallippalam, Josy J.; Krishna, Saloni; Suresh, Nitya; Sunny, Anita Ann; Karthikeyan, .; Iyer, Rajesh Shankar

doi:10.1016/j.inat.2021.101309

Cited by 2 publications

(8 citation statements)

References 26 publications

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“…If an older patient perceived a threat to their health after the onset of stroke symptoms, they were more likely to seek medical attention for prompt diagnosis and timely delivery of treatment. This finding was consistent with that of a previous study showing an association between perceived severity of stroke symptoms and hospital delay (Vallippalam et al, 2021). Another need factor that was tested in this study was stroke severity.…”

Section: Discussionsupporting

confidence: 93%

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

Butdee¹,

Juntasopeepun

Chintanawat

et al. 2022

Nursing & Health Sciences

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Acute ischemic stroke is a common medical emergency among older adults and requires immediate treatment. Prehospital delay limits the use of critical treatments, such as intravenous recombinant tissue plasminogen activators, leading to serious complications and often death. Using Andersen's Behavioral Model, this cross‐sectional study aimed to investigate and determine factors influencing prehospital delay among older persons with acute ischemic stroke. The participants consisted of 120 older persons with first‐time acute ischemic stroke diagnoses who received treatments at two hospitals in northern Thailand between November 2021 and February 2022. The results revealed that 70% of older persons experienced delays of over 3 hours following the onset of stroke symptoms. It was found that increased perceived severity of ischemic stroke and a shorter distance from home to the hospital were both associated with a reduced probability of prehospital delay. These findings highlight the significant factors influencing prehospital delay and suggest possible interventions to reduce prehospital delay among older patients with acute ischemic stroke.

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Section: Discussionsupporting

confidence: 93%

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

Butdee¹,

Juntasopeepun

Chintanawat

et al. 2022

Nursing & Health Sciences

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“…66% of our patients used emergency medical services (EMS) compared to 29% in the previous study. The OTD time of 5 h is also lesser than that recorded in the study conducted in Coimbatore in the neighboring state of Tamil Nadu with a median delay of 9.5 h. [ 7 ] However, 66% of the patients still arrived after 3.5 h. Among this, 17% of patients presented to the emergency department after 24 h. This is high compared to Western countries where 50–70% of patients arrive within 3 h, and the median OTD time is 1–2.5 h. [ 8 - 11 ]…”

Section: Discussionmentioning

confidence: 78%

“…[ 8 , 12 ] We found that 25.5% of patients recognized stroke, which is low compared to 70–75% in developed countries and another study in North Kerala. [ 7 ] Only 8 had knowledge about the warning symptoms of a stroke.…”

Section: Discussionmentioning

confidence: 99%

“…This was documented in many previous studies as well. [ 7 , 8 ] Only 17% of general practitioners are aware of the window period of thrombolysis according to a study from Tamil Nadu. [ 15 ] There is also a lack of knowledge about stroke-ready hospitals among both patients and doctors.…”

Section: Discussionmentioning

confidence: 99%

“…This was seen in other studies as well. [ 7 ] Patients from rural areas were seen to have lesser urgency about their symptoms compared to urban areas. 60.6% of patients who visited a local hospital also belonged to rural areas.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of onset-to-door time in acute ischemic stroke and factors associated with delay at a tertiary care center in South India

Anees,

Panicker,

Iype

et al. 2023

JNRP

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Objectives: Intravenous thrombolysis is an effective treatment of acute ischemic stroke but has a narrow therapeutic time window of 3–4.5 h. Pre-hospital delay is a major barrier to patients becoming eligible for thrombolysis. This single-center study assessed the factors causing longer onset-to-door (OTD) time to identify measures that will help decrease the delay. Materials and Methods: Patients with acute ischemic stroke presenting to the emergency department from August to October 2022 were included in the study. The data were collected using a structured questionnaire and was completed by interviewing the patient or the caregivers. Patients were classified as early and late arrivers with the cutoff being 3.5 h. We then analyzed the relationship between early arrival and demographic factors, clinical factors, patient response factors, and logistic factors. Results: Our study consisted of 153 patients. The average OTD time was 674.33 ± 812.713 min (median: 300; interquartile range: 151–885). The pre-hospital delay was present in 66% of patients. 16.9% of patients came beyond 24 h. In the multivariate analysis, the odds of early arrival were higher among patients who perceived their symptoms as serious (odds ratio [OR]: 18.801; confidence interval [CI]: 3.728–94.803) and lower among patients who experienced a delay in reaching due to traffic (OR: 0.085; CI: 0.008–0.873). Lack of knowledge about stroke centers among both patients and health professionals also contributed to longer OTD times. Out of 52 early arrivers, 24 received thrombolytic therapy after excluding wake-up strokes and contraindications. Conclusion: Pre-hospital delay continues to stand in the way of patients receiving thrombolysis. Comprehensive stroke education, increasing awareness regarding stroke centers, and promoting ambulance services are some of the interventions which could help tackle the issue.

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Stroke education focusing on recognition and response to decrease pre-hospital delay in India: Need of the hour to save hours

Cited by 2 publications

References 26 publications

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

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

Assessment of onset-to-door time in acute ischemic stroke and factors associated with delay at a tertiary care center in South India

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