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Jiang Y, Zhao Q, Guan J, Wang Y, Chen J, Li Y. Analyzing prehospital delays in recurrent acute ischemic stroke: Insights from interpretable machine learning. PATIENT EDUCATION AND COUNSELING 2024; 123:108228. [PMID: 38458092 DOI: 10.1016/j.pec.2024.108228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE This study investigates prehospital delays in recurrent Acute Ischemic Stroke (AIS) patients, aiming to identify key factors contributing to these delays to inform effective interventions. METHODS A retrospective cohort analysis of 1419 AIS patients in Shenzhen from December 2021 to August 2023 was performed. The study applied the Extreme Gradient Boosting (XGBoost) algorithm and SHapley Additive exPlanations (SHAP) for identifying determinants of delay. RESULTS Living with others and lack of stroke knowledge emerged as significant risk factors for delayed hospital presentation in recurrent AIS patients. Key features impacting delay times included residential status, awareness of stroke symptoms, presence of conscious disturbance, diabetes mellitus awareness, physical weakness, mode of hospital presentation, type of stroke, and presence of coronary artery disease. CONCLUSION Prehospital delays are similarly prevalent among both recurrent and first-time AIS patients, highlighting a pronounced knowledge gap in the former group. This discovery underscores the urgent need for enhanced stroke education and management. PRACTICE IMPLICATION The similarity in prehospital delay patterns between recurrent and first-time AIS patients emphasizes the necessity for public health initiatives and tailored educational programs. These strategies aim to improve stroke response times and outcomes for all patients.
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Affiliation(s)
- Youli Jiang
- Department of Neurology, People's Hospital of Longhua, 38 Jinglong Jianshe Road, Longhua District, Shenzhen 518109, China
| | - Qingshi Zhao
- Department of Neurology, People's Hospital of Longhua, 38 Jinglong Jianshe Road, Longhua District, Shenzhen 518109, China
| | - Jincheng Guan
- Department of Neurology, People's Hospital of Longhua, 38 Jinglong Jianshe Road, Longhua District, Shenzhen 518109, China
| | - Yuying Wang
- Department of Neurology, People's Hospital of Longhua, 38 Jinglong Jianshe Road, Longhua District, Shenzhen 518109, China
| | - Jingfang Chen
- The Third People's Hospital of Shenzhen, Shenzhen 518112, China; National Clinical Research Center for Infectious Diseases, 29 Bulan Road, Longgang District, Shenzhen 518112, China.
| | - Yanfeng Li
- Department of Neurology, People's Hospital of Longhua, 38 Jinglong Jianshe Road, Longhua District, Shenzhen 518109, China.
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Liao Y, Qi W, Li S, Shi X, Wu X, Chi F, Xia R, Qin L, Cao L, Ren L. Analysis of onset-to-door time and its influencing factors in Chinese patients with acute ischemic stroke during the 2020 COVID-19 epidemic: a preliminary, prospective, multicenter study. BMC Health Serv Res 2024; 24:615. [PMID: 38730381 PMCID: PMC11084012 DOI: 10.1186/s12913-024-11088-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/08/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Pre-hospital delay in China is a serious issue with unclear relevant reasons, seriously impeding the adoption of appropriate measures. Herein, we analyzed the onset-to-door time (ODT) in Chinese patients with acute ischemic stroke (AIS) and its influencing factors. METHODS We prospectively recruited 3,459 patients with AIS from nine representative tertiary general hospitals in China between January and June 2022. Patients were divided into ODT ≤ 3 h and ODT > 3 h groups. Following single-factor analysis, binary logistic regression analysis was performed to evaluate the risk factors leading to pre-hospital delay. RESULTS In total, 763 (21.83%) patients arrived at the hospital within 3 h of onset. After adjusting for confounding factors, the risk factors for ODT were residence in rural areas (odds ratio [OR]: 1.478, 95% credibility interval [CI]: 1.024-2.146) and hospital transfer (OR: 7.479, 95% CI: 2.548-32.337). The protective factors for ODT were location of onset ≤ 20 km from the first-visit hospital (OR: 0.355, 95% CI: 0.236-0.530), transportation by emergency medical services (OR: 0.346, 95% CI: 0.216-0.555), history of atrial fibrillation (OR: 0.375, 95% CI: 0.207-0.679), moderate stroke (OR: 0.644, 95% CI: 0.462-0.901), and severe stroke (OR: 0.506, 95% CI: 0.285-0.908). CONCLUSIONS Most patients with AIS fail to reach a hospital within the critical 3-h window. The following measures are recommended to reduce pre-hospital delays: reasonable distribution of hospitals accessible to nearby residents, minimizing interhospital transfer, paying attention to patients with mild stroke, and encouraging patients to use ambulance services. Pre-hospital delays for patients can be reduced by implementing these measures, ultimately improving the timeliness of treatment and enhancing patient prognosis. This study was carried out amid the COVID-19 pandemic, which presented challenges and constraints.
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Affiliation(s)
- Yuqi Liao
- School of Medicine, Shenzhen University, Shenzhen, China
| | - Wenwei Qi
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuting Li
- School of Statistics, Shandong Technology and Business University, Yantai, China
| | - Xin Shi
- School of Statistics, Shandong Technology and Business University, Yantai, China
- School of Health Management, China Medical University, Shenyang, China
| | - Xiaohong Wu
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, 3002 Sungang West Road, Futian District, Shenzhen City, 518000, China
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Feng Chi
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, 3002 Sungang West Road, Futian District, Shenzhen City, 518000, China
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Runyu Xia
- School of Medicine, Shenzhen University, Shenzhen, China
| | - Limin Qin
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, 3002 Sungang West Road, Futian District, Shenzhen City, 518000, China
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Liming Cao
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, 3002 Sungang West Road, Futian District, Shenzhen City, 518000, China.
- Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha, China.
| | - Lijie Ren
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, 3002 Sungang West Road, Futian District, Shenzhen City, 518000, China
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, China
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Jiang Y, Xiong Y, Chi Y, Lin F, Zhao Q, Li Y. Healthcare-Seeking Delays in Acute Ischemic Stroke Patients: The Influence of Gender, Immigrant Status, and Educational Background. Risk Manag Healthc Policy 2024; 17:191-204. [PMID: 38264584 PMCID: PMC10803282 DOI: 10.2147/rmhp.s445001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024] Open
Abstract
Purpose Timely medical attention is crucial for patients with Acute Ischemic Stroke (AIS), as delays can significantly impact therapeutic outcomes. These delays are influenced by a combination of socio-cultural, educational, and clinical factors. Patients and Methods An in-depth analysis was conducted to assess the prevalence and median duration of healthcare-seeking delays in AIS patients. The study specifically investigated the independent impacts of sociocultural and clinical determinants on these delays, with a focus on immigrant status, gender disparities, and educational levels. Multivariate regression analysis was employed to identify these independent effects while controlling for potential confounding factors. Results Among 1419 AIS patients, 82.52% (n = 1171) experienced delays exceeding 2 hours from symptom onset of symptoms to hospital arrival. The median delay was 12.3 hours. Immigrant populations encountering longer delays compared to native groups. Younger males (<45 years) and elderly females were more prone to delay in healthcare-seeking. Identified independent risk factors for delay included male gender (OR = 1.65 [95% CI:1.14-2.48]), self-acknowledged diabetes (OR = 2.50 [95% CI:1.21-5.17]), small vessel (OR = 2.07 [95% CI:1.27-3.36]), and wake stroke (OR = 7.04 [95% CI:3.69-13.44]). Educational background (high school and above), GCS score with 3-8 points (OR = 0.52 [95% CI:0.09-0.69]), understanding stroke-related knowledge (OR = 0.26 [95% CI:0.09-0.44]), conscious disturbance (OR = 0.25 [95% CI:0.10-0.62]) and limb weakness (OR=0.21[95% CI:0.21-0.49]) are protective factors for timely treatment. Conclusion Immigrant populations experienced longer delays from symptom onset to hospital arrival. The crucial roles of education and knowledge about stroke underscore the need for enhanced health literacy campaigns and public awareness, with a targeted focus on younger males and elderly females.
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Affiliation(s)
- Youli Jiang
- Department of Neurology, People’s Hospital of Longhua, Shenzhen, 518109, People’s Republic of China
| | - Yao Xiong
- Department of Neurology, People’s Hospital of Longhua, Shenzhen, 518109, People’s Republic of China
| | - Yue Chi
- Department of Neurology, People’s Hospital of Longhua, Shenzhen, 518109, People’s Republic of China
| | - Fu Lin
- Department of Neurology, People’s Hospital of Longhua, Shenzhen, 518109, People’s Republic of China
| | - Qingshi Zhao
- Department of Neurology, People’s Hospital of Longhua, Shenzhen, 518109, People’s Republic of China
| | - Yanfeng Li
- Department of Neurology, People’s Hospital of Longhua, Shenzhen, 518109, People’s Republic of China
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Yuan J, Lu ZK, Xiong X, Li M, Liu Y, Wang LD, Liu R, Zhao J. Age and geographic disparities in acute ischaemic stroke prehospital delays in China: a cross-sectional study using national stroke registry data. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 33:100693. [PMID: 37181525 PMCID: PMC10166992 DOI: 10.1016/j.lanwpc.2023.100693] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/26/2022] [Accepted: 01/03/2023] [Indexed: 05/16/2023]
Abstract
Background Stroke has been the leading cause of death in China for decades. The extremely low intravenous thrombolysis rate is largely due to the prehospital delays that make patients ineligible for the time-sensitive therapy. Limited studies evaluated prehospital delays across China. We investigated prehospital delays in the stroke population across China and the associated age, rurality, and geographic disparities. Methods A cross-sectional study design was employed using the Bigdata Observatory platform for Stroke of China in 2020, the nationwide, prospective, multicentre registry of patients with acute ischaemic stroke (AIS). Mixed-effect regression models were used to account for the clustered data. Findings The sample contained 78,389 AIS patients. The median onset-to-door (OTD) time was 24 h, with only 11.79% (95% confidence interval [CI]: 11.56-12.02%) patients arriving at hospitals within 3 h. About 12.43% (95% CI: 12.11-12.74%) of patients 65 years or older arrived at hospitals within 3 h, which was significantly higher than the young and middle-aged patients (11.03%; 95% CI: 10.71-11.36%). After controlling for potential confounders, young and middle-aged patients were less likely to present to hospitals within 3 h (adjusted odds ratio: 0.95; 95% CI: 0.90-0.99) compared to patients 65 years or older. The 3-h hospital arrival rate was the highest in Beijing (18.40%, 95% CI: 16.01-20.79%), which was almost 5 times higher than that in Gansu (3.45%, 95% CI: 2.69-4.20%). The arrival rate in urban areas was almost 2 times higher than that in rural areas (13.35% versus. 7.66%). Interpretation We found that the low rates of timely arrival at hospitals after a stroke is more salient in the younger population, rural settings, or those residing in less developed geographic regions. This study calls for more tailored interventions focusing on younger people, rural areas, and less developed geographic regions. Funding The National Natural Science Foundation of China; CIHR, Grant/Award Number: 81973157, PI: JZ. Natural Science Foundation of Shanghai; CIHR, Grant/Award Number: 17dz2308400, PI: JZ. Funding from the University of Pennsylvania; Grant/Award Number: CREF-030, PI: RL.
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Affiliation(s)
- Jing Yuan
- Department of Clinical Pharmacy, School of Pharmacy, Fudan University, 826 Zhangheng Road, Pudong District, Shanghai, 201203, PR China
| | - Z. Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, 715 Sumter Street, CLS Building 311, Columbia, SC, 29208, USA
| | - Xiaomo Xiong
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, 715 Sumter Street, CLS Building 311, Columbia, SC, 29208, USA
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis TN, USA
| | - Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai, 201100, PR China
| | - Long-De Wang
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, 100053, PR China
| | - Renyu Liu
- Departments of Anesthesiology and Critical Care, and Neurology, Perelman School of Medicine at the University of Pennsylvania, 336 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai, 201100, PR China
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Liu T, Jiang Y, Hu J, Li Z, Li X, Xiao J, Yuan L, He G, Zeng W, Rong Z, Zhu S, Ma W, Wang Y. Joint Associations of Short-Term Exposure to Ambient Air Pollutants with Hospital Admission of Ischemic Stroke. Epidemiology 2023; 34:282-292. [PMID: 36722811 DOI: 10.1097/ede.0000000000001581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies have estimated the associations of short-term exposure to ambient air pollution with ischemic stroke. However, the joint associations of ischemic stroke with air pollution as a mixture remain unknown. METHODS We employed a time-stratified case-crossover study to investigate 824,808 ischemic stroke patients across China. We calculated daily mean concentrations of particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5), maximum 8-h average for O3 (MDA8 O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO) across all monitoring stations in the city where the IS patients resided. We conducted conditional logistic regression models to estimate the exposure-response associations. RESULTS Results from single-pollutant models showed positive associations of hospital admission for ischemic stroke with PM2.5 (excess risk [ER] = 0.38%, 95% confidence interval [CI]: 0.29% to 0.47%, for 10 μg/m3), MDA8 O3 (ER = 0.29%, 95% CI: 0.18% to 0.40%, for 10 μg/m3), NO2 (ER = 1.15%, 95% CI: 0.92% to 1.39%, for 10 μg/m3), SO2 (ER = 0.82%, 95% CI: 0.53% to 1.11%, for 10 μg/m3) and CO (ER = 3.47%, 95% CI: 2.70% to 4.26%, for 1 mg/m3). The joint associations (ER) with all air pollutants (for interquartile range width increases in each pollutant) estimated by the single-pollutant model was 8.73% and was 4.27% by the multipollutant model. The joint attributable fraction of ischemic stroke attributable to air pollutants based on the multipollutant model was 7%. CONCLUSIONS Short-term exposures to PM2.5, MDA8 O3, NO2, SO2, and CO were positively associated with increased risks of hospital admission for ischemic stroke. The joint associations of air pollutants with ischemic stroke might be overestimated using single-pollutant models. See video abstract at, http://links.lww.com/EDE/C8.
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Affiliation(s)
- Tao Liu
- From the Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
- Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou 510632, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, 100070, China
| | - Jianxiong Hu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430; China
| | - Zixiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, 100070, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 100070, China
| | - Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430; China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430; China
| | - Lixia Yuan
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430; China
| | - Guanhao He
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430; China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430; China
| | - Zuhua Rong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430; China
| | - Sui Zhu
- From the Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
- Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou 510632, China
| | - Wenjun Ma
- From the Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
- Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou 510632, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, 100070, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 100070, China
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Liu J, Wang M, Zhao Y, Chen H, Liu H, Yang B, Shan H, Li H, Shi Y, Wang L, Wang G, Han C. Associations between short-term exposure to ambient PM 2.5 and incident cases of cerebrovascular disease in Yantai, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:21970-21977. [PMID: 36282388 DOI: 10.1007/s11356-022-23626-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
There are limited studies examining the association between PM2.5 exposure and incident cerebrovascular disease (CD) cases in China. In this study, daily counts of incident CD cases and daily PM2.5 concentrations were obtained in Yantai, Shandong Province, China from 2014 to 2019. We used a combination of the Poisson-distribution generalized linear model (GLM) and a distributed lag nonlinear model (DLNM) to examine the association of short-term exposure to ambient PM2.5 and incident cases of CD. The results revealed that for every 10 μg/m3 increment of PM2.5 would increase the incident CD cases by 0.216% (RR:1.00216, 95%CI:1.0016-1.0028) at lag4. The stratified analysis demonstrated that the females and residents aged 65 years or above presented higher short-term PM2.5-associated CD risks than the males and aged below 65 years. Targeted prevention strategies should be adopted to reduce the PM2.5-related CD burden, especially for the susceptible population in China.
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Affiliation(s)
- Junyan Liu
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Maobo Wang
- Yantai Center for Disease Control and Prevention, Yantai, 264003, Shandong, China
| | - Yang Zhao
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China
| | - Haotian Chen
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Haiyun Liu
- Department of Public Health, Shandong College of Traditional Chinese Medicine, 264199, Yantai, China
| | - Baoshun Yang
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Haifeng Shan
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Hongyu Li
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Yukun Shi
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Luyang Wang
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Guangcheng Wang
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Chunlei Han
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China.
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Liu T, Jiang Y, Hu J, Li Z, Guo Y, Li X, Xiao J, Yuan L, He G, Zeng W, Kan H, Rong Z, Chen G, Yang J, Wang Y, Ma W. Association of ambient PM 1 with hospital admission and recurrence of stroke in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 828:154131. [PMID: 35219663 DOI: 10.1016/j.scitotenv.2022.154131] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/10/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Particulate matter (PM) pollution is a well-known risk factor of stroke. However, little is known about the association between PM1 (aerodynamic diameter ≤ 1.0 μm) and stroke. We estimated the associations of short-term exposure to PM1 with hospital admission and recurrence of stoke in China. METHODS Stroke data were derived from the Chinese Stroke Center Alliance (CASA) program conducted in 1458 hospitals in 292 Chinese cities from 2015 to 2019. Daily air pollution and meteorological data were collected in the cities where studied hospitals were located. Daily PM1 concentration was estimated by a generalized additive model (GAM) using PM2.5 and meteorological variables. A time-stratified case-crossover design was applied to estimate the associations of short-term exposure to PM1 with hospital admission of stroke. A GAM model was used to estimate the association between average PM1 exposure during hospitalization and the recurrence of stroke. RESULTS A total of 989,591 stroke cases were included in the study. Each 10 μg/m3 increase in PM1 (lag06-day) was associated with a 0.53% (95%CI, 0.39%, 0.67%) increment in hospital admission for stroke. The adverse effects of PM1 on ischemic stroke was stronger than on intracerebral hemorrhage. We found the associations were significant in Northeast (0.94%, 95%CI, 0.51%, 1.38%), North (0.47%, 95%CI, 0.20%, 0.75%), Central (0.57%, 95%CI, 0.30%, 0.85%), and East China (0.63%, 95%CI, 0.27%, 0.99%). Of all stroke cases, 62,988 (6.4%) had recurrent stoke attack during their hospitalization. Each 10 μg/m3 increase in PM1 was associated with a 1.64% (95%CI, 1.28%, 2.01%) increment in recurrence of stroke during hospitalization. CONCLUSIONS Short-term exposure to PM1 may increase the risk of incidence and recurrence of stroke in China, and the effects varied across different types of stroke and regions. Geographically targeted strategies and measures are needed to control air pollution for reducing the burden of stroke from PM1.
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Affiliation(s)
- Tao Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 510632 Guangzhou, China; Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou 510632, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Jianxiong Hu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Zixiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing 100070, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 100070, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3800, Australia
| | - Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Lixia Yuan
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Guanhao He
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China; Children's Hospital of Fudan University, National Center for Children's Health, Shanghai 200032, China
| | - Zuhua Rong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Gongbo Chen
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Jun Yang
- Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing 100070, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 100070, China.
| | - Wenjun Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 510632 Guangzhou, China; Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou 510632, China.
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8
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Identification and analysis of key risk factors for prehospital delay in patients with stroke. Int Emerg Nurs 2022; 62:101156. [DOI: 10.1016/j.ienj.2022.101156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/27/2022] [Accepted: 02/11/2022] [Indexed: 01/18/2023]
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9
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Association of short-term exposure to air pollution with recurrent ischemic cerebrovascular events in older adults. Int J Hyg Environ Health 2022; 240:113925. [PMID: 35045384 DOI: 10.1016/j.ijheh.2022.113925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 11/22/2022]
Abstract
The acute effects of ambient air pollution on recurrence of ischemic cerebrovascular events (ICEs) remains largely unknown. We therefore conducted a time-stratified case-crossover study of 43,896 patients who were 60 years or older and were admitted to hospital for recurrent ICEs including ischemic stroke and transient ischemic attack in Guangzhou, China during 2016-2019. Based on each patient's home address and pollutant data from its neighboring air quality monitoring stations, we used an inverse distance weighting method to assess exposures to particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5), particulate matter with an aerodynamic diameter ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and ozone (O3). Conditional logistic regression models were used to quantify exposure-response associations. During the study period, there were 43,896 case days and 149,131 control days. In single-pollutant models, each 10 μg/m3 increase in exposure to PM10, NO2 and CO (mean exposure on date of admission and 1 day prior) was significantly associated with a 0.74% (95% confidence interval [CI]: 0.13-1.36%), 2.15% (1.38-2.93%) and 0.14% (0.07-0.21%) increase in odds of hospital admissions for recurrent ICEs, respectively, and no significant departures from linearity were detected. The association for NO2 exposure remained consistent in 2-pollutant models, while the associations for PM10 and CO disappeared or changed materially with adjustment for other pollutants. Stronger association for NO2 exposure was observed in cool season than that in warm season. We found that short-term exposure to ambient air pollutants, especially NO2, was associated with increased risk of hospital admissions for recurrent ICEs in older adults.
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Kircher CE, Adeoye O. Prehospital and Emergency Department Care of the Patient With Acute Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Lee CH, Wang H. Multiple imputation confidence intervals for the mean of the discrete distributions for incomplete data. Stat Med 2021; 41:1172-1190. [PMID: 34786744 DOI: 10.1002/sim.9254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/10/2021] [Accepted: 10/19/2021] [Indexed: 11/08/2022]
Abstract
Confidence intervals for the mean of discrete exponential families are widely used in many applications. Since missing data are commonly encountered, the interval estimation for incomplete data is an important problem. The performances of the existing multiple imputation confidence intervals are unsatisfactory. We propose modified multiple imputation confidence intervals to improve the existing confidence intervals for the mean of the discrete exponential families with quadratic variance functions. A simulation study shows that the coverage probabilities of the modified confidence intervals are closer to the nominal level than the existing confidence intervals when the true mean is near the boundaries of the parameter space. These confidence intervals are also illustrated with real data examples.
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Affiliation(s)
- Chung-Han Lee
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Hsiuying Wang
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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12
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Gu S, Dai Z, Shen H, Bai Y, Zhang X, Liu X, Xu G. Delayed Stroke Treatment during COVID-19 Pandemic in China. Cerebrovasc Dis 2021; 50:715-721. [PMID: 34247153 PMCID: PMC8339026 DOI: 10.1159/000517075] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/17/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Social distance, quarantine, pathogen testing, and other preventive strategies implemented during CO-VID-19 pandemic may negatively influence the management of acute ischemic stroke (AIS). OBJECTIVE The current study aimed to evaluate the impacts of COVID-19 pandemic on treatment delay of AIS in China. METHODS This study included patients with AIS admitted in 2 hospitals in Jiangsu, China. Patients admitted before and after the COVID-19 pandemic outbreak (January 31, 2020, as officially announced by the Chinese government) were screened to collect sociodemographic data, medical history information, and symptom onset status from clinical medical records and compared for pre- (measured as onset-to-door time [ODT]) and posthospital delay (measured as door-to-needle time [DNT]). The influencing factors for delayed treatment (indicated as onset-to-needle time >4.5 h) were analyzed with multivariate logistic regression analysis. RESULTS A total of 252 patients were included, of which 153 (60.7%) were enrolled before and 99 (39.3%) after the COVID-19 pandemic. ODT increased from 202 min (interquartile range [IQR] 65-492) before to 317 min (IQR 75-790) after the COVID-19 pandemic (p = 0.001). DNT increased from 50 min (IQR 40-75) before to 65 min (IQR 48-84) after the COVID-19 pandemic (p = 0.048). The proportion of patients with intravenous thrombolysis in those with AIS was decreased significantly after the pandemic (15.4% vs. 20.1%; p = 0.030). Multivariate logistic regression analysis indicated that patients after COVID-19 pandemic, lower educational level, rural residency, mild symptoms, small artery occlusion, and transported by other means than ambulance were associated with delayed treatment. CONCLUSIONS COVID-19 pandemic has remarkable impacts on the management of AIS. Both pre- and posthospital delays were prolonged significantly, and proportion of patients arrived within the 4.5-h time window for intravenous thrombolysis treatment was decreased. Given that anti-COVID-19 measures are becoming medical routines, efforts are warranted to shorten the delay so that the outcomes of stroke could be improved.
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Affiliation(s)
- Shiyuan Gu
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, China
- Department of Neurology, Affiliated Yixing Hospital of Jiangsu University, Yixing, China
| | - Zhengze Dai
- Department of Neurology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing Pukou Hospital, Nanjing, China
| | - Huachao Shen
- Department of Neurology, BenQ Medical Center, Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Yongjie Bai
- Department of Neurology, First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Xiaohao Zhang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, China
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Gelin Xu
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, China
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Kharbach A, Obtel M, Achbani A, Aasfara J, Hassouni K, Lahlou L, Razine R. Ischemic stroke in Morocco: Prehospital delay and associated factors. Rev Epidemiol Sante Publique 2021; 69:345-359. [PMID: 34148762 DOI: 10.1016/j.respe.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco. PATIENTS AND METHODS An observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department. RESULTS A total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6hours (IQR, 4-16). Multiple regression analysis showed that illiteracy (OR 38.58; CI95%: 3.40-437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI95%: 1.57-80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI95%: 0.01-0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI95%: 0.00-0.36), and direct admission without reference (OR 0.005; CI95%: 0.00-0.07), were independently associated with late arrival (>4.5hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI95%: 4.37-138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI95%: 0.03-0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI95%: 0.00-0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI95%: 0.03-0.80), distance between 50 and 100km (OR 10.16; CI95%: 1.16-89.33), and direct admission without reference (OR 0.03; CI95%: 0.00-0.14), were independently associated with late arrival (>6hours) of patients with acute ischemic stroke. CONCLUSION Patient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.
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Affiliation(s)
- A Kharbach
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
| | - M Obtel
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco; Laboratory of Social Medicine (Public Health, Hygiene and Preventive Medicine), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
| | - A Achbani
- Laboratory of Cell Biology and Molecular Genetics (LBCGM), Department of Biology, Faculty of Sciences, University Ibn Zohr Agadir, Rabat, Morocco.
| | - J Aasfara
- Department of Neurology, International Cheikh Khalifa University Hospital, Mohammed VI University of Health Sciences (UM6SS) Casablanca, Rabat, Morocco.
| | - K Hassouni
- International School of Public Health, Mohammed VI University of Health Sciences (UM6SS) Casablanca, Rabat, Morocco.
| | - L Lahlou
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco; Faculty of Medicine and Pharmacy of Agadir, University Ibn Zohr, Agadir, Morocco.
| | - R Razine
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco; Laboratory of Social Medicine (Public Health, Hygiene and Preventive Medicine), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
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Pradhan RR, Jha A, Bhandari S, Ojha S, Karn R. Knowledge, attitude, and practice of stroke and thrombolysis among students preparing for undergraduate medical entrance examination in Kathmandu, Nepal. Health Sci Rep 2021; 4:e268. [PMID: 33842697 PMCID: PMC8020573 DOI: 10.1002/hsr2.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/29/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Stroke is a major disabling disease, especially for low and middle-income countries like Nepal. The aim of our study is to assess knowledge, attitude, and practice (KAP) among the students preparing for undergraduate medical entrance examination regarding risk factors, warning signs and symptoms, and management of stroke. METHODS A cross-sectional, single staged study using self-structured questionnaire intended to assess KAP about stroke and thrombolysis was conducted. RESULTS A total of 378 students participated in our study (53% male; mean age = 18.12 ± 0.97). Majority of the participants (88.4%) had heard about stroke. The more common risk factors identified by them were hypertension (86.2%), oily food (48%), alcohol (37.8%), and smoking (32.8%). Limb weakness, slurring of speech and facial weakness as symptoms and signs of stroke were indicated by 43.4%, 30.2%, and 18.8% of the participants, respectively. Only 23.8% of the participants had heard about thrombolysis and 10% of all could rightly mention the window period of thrombolysis. Male participants had better knowledge about smoking [86 (43.0) vs 38 (21.3); P < .001] and oily food [108 (54.0) vs 73 (41.0); P = .012] being risk factors and facial weakness [50 (37.6) vs 21 (11.8); P = .001] being symptom of stroke compared with females. Similarly, male participants had heard more about thrombolysis than females [68 (34.0) vs 22 (12.4); P < .001]. CONCLUSION Knowledge regarding risk factors and signs and symptoms of stroke was adequate among the students preparing for undergraduate medical entrance examination. However, knowledge about thrombolysis was poor. Male participants had better knowledge about risk factors, warning signs and symptoms of stroke, and thrombolysis compared with female.
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Affiliation(s)
| | - Ashish Jha
- Institute of MedicineTribhuvan University Teaching HospitalKathmanduNepal
| | | | - Sujan Ojha
- Institute of MedicineTribhuvan University Teaching HospitalKathmanduNepal
| | - Ragesh Karn
- Institute of MedicineTribhuvan University Teaching HospitalKathmanduNepal
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Wang R, Wang Z, Yang D, Wang J, Gou C, Zhang Y, Xian L, Wang Q. Early Hospital Arrival After Acute Ischemic Stroke Is Associated With Family Members' Knowledge About Stroke. Front Neurol 2021; 12:652321. [PMID: 34122301 PMCID: PMC8187751 DOI: 10.3389/fneur.2021.652321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose: Prehospital delay is the major factor limiting intravenous thrombolysis and mechanical thrombectomy in acute ischemic stroke (AIS). This study aimed to: (1) identify factors related to prehospital delay and (2) determine the impact of recognition and behavior of family members on patient delay. Methods: A cross-sectional, multicenter study was conducted at six teaching hospitals in China between December 1, 2018 and November 30, 2019. Patients who experienced AIS within 7 days of onset were interviewed. Results: Of 1,782 consecutive patients (male, 57.97%; mean age, 66.3 ± 9.65 years) who had an AIS, 267 (14.98%) patients arrived within 4.5 h and 722 (40.52%) patients arrived within 6 h of stroke onset. Among patients who arrived within 4.5 h, 103 (38.6%) received thrombolysis. Age over 65 years (OR, 2.009; 95% CI, 1.014-3.982), prior stroke (OR, 3.478; 95% CI, 1.311-9.229), blurred vision (OR, 3.95; 95% CI, 1.71-9.123), and patients deciding to seek medical help (OR, 3.097; 95% CI, 1.417-6.769) were independently associated with late arrival. In contrast, sudden onset of symptoms (OR, 0.075; 95% CI, 0.028-0.196), the National Institutes of Health Stroke Scale 7-15 (OR, 0.093; 95% CI, 0.035-0.251), consciousness disturbance (OR, 0.258; 95% CI, 0.091-0.734), weakness (OR, 0.265; 95% CI, 0.09-0.784), arrival by ambulance (OR, 0.102; 95% CI, 0.049-0.211), decision time <30 min (OR, 0.008; 95% CI, 0.003-0.018), and family member understanding stroke requires early treatment (OR, 0.224; 95% CI, 0.109-0.462) were independently associated with early arrival. Conclusions: The prehospital delay in China lags behind Western countries. Recognition and behavior of stroke patients' family members may play a key role in early arrival.
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Affiliation(s)
- Rongyu Wang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhiqiang Wang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dongdong Yang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jian Wang
- Department of Neurology, Yaan People's Hospital, Yaan, China
| | - Chongji Gou
- Department of Neurology, Pengzhou People's Hospital, Pengzhou, China
| | - Yaodan Zhang
- Department of Neurology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Liulin Xian
- Department of Neurology, Nanbu Traditional Chinese Medicine, Nanbu, China
| | - Qingsong Wang
- Department of Neurology, The General Hospital of Western Theater Command, Chengdu, China
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Lee EJ, Kim SJ, Bae J, Lee EJ, Kwon OD, Jeong HY, Kim Y, Jeong HB. Impact of onset-to-door time on outcomes and factors associated with late hospital arrival in patients with acute ischemic stroke. PLoS One 2021; 16:e0247829. [PMID: 33765030 PMCID: PMC7993794 DOI: 10.1371/journal.pone.0247829] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/14/2021] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Previous studies have reported that early hospital arrival improves clinical outcomes in patients with acute ischemic stroke; however, whether early arrival is associated with favorable outcomes regardless of reperfusion therapy and the type of stroke onset time is unclear. Thus, we investigated the impact of onset-to-door time on outcomes and evaluated the predictors of pre-hospital delay after ischemic stroke. Methods Consecutive acute ischemic stroke patients who arrived at the hospital within five days of onset from September 2019 to May 2020 were selected from the prospective stroke registries of Seoul National University Hospital and Chung-Ang University Hospital of Seoul, Korea. Patients were divided into early (onset-to-door time, ≤4.5 h) and late (>4.5 h) arrivers. Multivariate analyses were performed to assess the effect of early arrival on clinical outcomes and predictors of late arrival. Results Among the 539 patients, 28.4% arrived early and 71.6% arrived late. Early hospital arrival was significantly associated with favorable outcomes (three-month modified Rankin Scale [mRS]: 0−2, adjusted odds ratio [aOR]: 2.03, 95% confidence interval: [CI] 1.04–3.96) regardless of various confounders, including receiving reperfusion therapy and type of stroke onset time. Furthermore, a lower initial National Institute of Health Stroke Scale (NIHSS) score (aOR: 0.94, 95% CI: 0.90–0.97), greater pre-stroke mRS score (aOR: 1.58, 95% CI: 1.18–2.13), female sex (aOR: 1.71, 95% CI: 1.14–2.58), unclear onset time, and ≤6 years of schooling (aOR: 1.76, 95% CI: 1.03–3.00 compared to >12 years of schooling) were independent predictors of late arrival. Conclusions Thus, the onset-to-door time of≤4.5 h is crucial for better clinical outcome, and lower NIHSS score, greater pre-stroke mRS score, female sex, unclear onset times, and ≤6 years of schooling were independent predictors of late arrival. Therefore, educating about the importance of early hospital arrival after acute ischemic stroke should be emphasized. More strategic efforts are needed to reduce the prehospital delay by understanding the predictors of late arrival.
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Affiliation(s)
- Eung-Joon Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Jae Kim
- Department of Family Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- International Healthcare Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeonghoon Bae
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun Ji Lee
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Oh Deog Kwon
- Republic of Korea Navy 2 Fleet Medical Corps, Pyeongtaek-si, Gyeonggi-do, Republic of Korea
| | - Han-Yeong Jeong
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yongsung Kim
- Department of Neurology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Hae-Bong Jeong
- Department of Neurology, Chung-Ang University Hospital, Seoul, Republic of Korea
- * E-mail:
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Sherman V, Martino R, Bhathal I, DeVeber G, Dlamini N, MacGregor D, Pulcine E, Beal DS, Thorpe KE, Moharir M. Swallowing, Oral Motor, Motor Speech, and Language Impairments Following Acute Pediatric Ischemic Stroke. Stroke 2021; 52:1309-1318. [PMID: 33641384 DOI: 10.1161/strokeaha.120.031893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Following adult stroke, dysphagia, dysarthria, and aphasia are common sequelae. Little is known about these impairments in pediatric stroke. We assessed frequencies, co-occurrence and associations of dysphagia, oral motor, motor speech, language impairment, and caregiver burden in pediatric stroke. METHODS Consecutive acute patients from term birth-18 years, hospitalized for arterial ischemic stroke (AIS), and cerebral sinovenous thrombosis, from January 2013 to November 2018 were included. Two raters reviewed patient charts to detect documentation of in-hospital dysphagia, oral motor dysfunction, motor speech and language impairment, and caregiver burden, using a priori operational definitions for notation and assessment findings. Other variables abstracted included demographics, preexisting conditions, stroke characteristics, and discharge disposition. Impairment frequencies were obtained by univariate and bivariate analysis and associations by simple logistic regression. RESULTS A total of 173 patients were stratified into neonates (N=67, mean age 2.9 days, 54 AIS, 15 cerebral sinovenous thrombosis) and children (N=106, mean age 6.5 years, 73 AIS, 35 cerebral sinovenous thrombosis). Derived frequencies of impairments included dysphagia (39% neonates, 41% children); oral motor (6% neonates, 41% children); motor speech (37% children); and language (31% children). Common overlapping impairments included oral motor and motor speech (24%) and dysphagia and motor speech (23%) in children. Associations were found only in children between stroke type (AIS over cerebral sinovenous thrombosis) and AIS severity (more severe deficit at presentation) for all impairments except feeding impairment alone. Caregiver burden was present in 58% patients. CONCLUSIONS For the first time, we systematically report the frequencies and associations of dysphagia, oral motor, motor speech, and language impairment during acute presentation of pediatric stroke, ranging from 30% to 40% for each impairment. Further research is needed to determine long-term effects of these impairments and to design standardized age-specific assessment protocols for early recognition following stroke.
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Affiliation(s)
- Victoria Sherman
- Speech-Language Pathology, University of Toronto, ON, Canada (V.S., R.M., D.S.B.).,Rehabilitation Sciences Institute, University of Toronto, ON, Canada (V.S., R.M., D.S.B.).,Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada (V.S., I.B., G.D., N.D., D.M., E.P., M.M.)
| | - Rosemary Martino
- Speech-Language Pathology, University of Toronto, ON, Canada (V.S., R.M., D.S.B.).,Rehabilitation Sciences Institute, University of Toronto, ON, Canada (V.S., R.M., D.S.B.).,Otolaryngology Head and Neck Surgery, University of Toronto, ON, Canada (R.M.).,Krembil Research Institute, University Health Network, Toronto, ON, Canada (R.M.)
| | - Ishvinder Bhathal
- Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada (V.S., I.B., G.D., N.D., D.M., E.P., M.M.)
| | | | - Nomazulu Dlamini
- Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada (V.S., I.B., G.D., N.D., D.M., E.P., M.M.).,Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada (N.D.)
| | - Daune MacGregor
- Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada (V.S., I.B., G.D., N.D., D.M., E.P., M.M.)
| | - Elizabeth Pulcine
- Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada (V.S., I.B., G.D., N.D., D.M., E.P., M.M.)
| | - Deryk S Beal
- Speech-Language Pathology, University of Toronto, ON, Canada (V.S., R.M., D.S.B.).,Rehabilitation Sciences Institute, University of Toronto, ON, Canada (V.S., R.M., D.S.B.).,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada (D.S.B)
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, ON, Canada (K.E.T.).,Applied Health Research Centre St. Michael's Hospital, Toronto, ON, Canada (K.E.T.)
| | - Mahendranath Moharir
- Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada (V.S., I.B., G.D., N.D., D.M., E.P., M.M.)
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Qi X, Wang Z, Guo X, Xia X, Xue J, Jiang G, Gu Y, Han S, Yao Q, Cai Z, Wang X, Wang L, Leng SX, Li X. Short-term effects of outdoor air pollution on acute ischaemic stroke occurrence: a case-crossover study in Tianjin, China. Occup Environ Med 2020; 77:862-867. [PMID: 32855345 PMCID: PMC7677458 DOI: 10.1136/oemed-2019-106301] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 07/07/2020] [Accepted: 08/02/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Ambient air pollution is associated with ischaemic stroke incidence. However, most of the previous studies used stroke-related hospital admission rather than stroke onset itself. This study aimed to evaluate the relationship between ambient air pollutant exposures and acute ischaemic stroke based on the timing of symptom onset. METHODS A time-stratified, case-crossover analysis was performed among 520 patients who had ischaemic stroke admitted to the Second Hospital of Tianjin Medical University (Tianjin, China) between 1 April 2018 and 31 March 2019 (365 days). Daily air pollutant concentrations of particulate matter with aerodynamic diameter 2.5 µm, particulate matter with aerodynamic diameter 10 µm (PM10), sulfur dioxide, nitrogen dioxide, carbon monoxide and ozone were obtained from fixed-site monitoring stations. We used conditional logistic regression to estimate OR and 95% CI corresponding to an increase in IQR of each air pollutant after adjusting for the effects of temperature and relative humidity. RESULTS Overall, a higher risk of ischaemic stroke was found between April and September. During this period PM10 was associated with an increased risk of ischaemic stroke (1-day lag: OR=1.49, 95% CI 1.09 to 2.02; 3-day mean: OR=1.58, 95% CI 1.09 to 2.29) among patients between 34 and 70 years old. Positive associations were also observed between PM10 (1-day lag: OR=1.51, 95% CI 1.10 to 2.07; 3-day mean: OR=1.57, 95% CI 1.08 to 2.29), ozone (1-day lag: OR=1.83, 95% CI 1.16 to 2.87; 3-day mean: OR=1.90, 95% CI 1.06 to 3.42) and ischaemic stroke occurrence among those with hyperlipidaemia. CONCLUSION Our results suggest that air pollution is associated with a higher risk of ischaemic stroke in younger people or people with hyperlipidemia. These findings still need to be further investigated.
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Affiliation(s)
- Xuemei Qi
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhongyan Wang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaokun Guo
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Juanjuan Xue
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guojing Jiang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yumeng Gu
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Suqin Han
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research (CLAER/CMA-NKU), Tianjin Environmental Meteorology Center, Tianjin, China
| | - Qing Yao
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research (CLAER/CMA-NKU), Tianjin Environmental Meteorology Center, Tianjin, China
| | - Ziying Cai
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research (CLAER/CMA-NKU), Tianjin Environmental Meteorology Center, Tianjin, China
| | - Xiaojia Wang
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research (CLAER/CMA-NKU), Tianjin Environmental Meteorology Center, Tianjin, China
| | - Lin Wang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
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Chen L, Zhang Y, Zhang W, Chen G, Lu P, Guo Y, Li S. Short-term effect of PM 1 on hospital admission for ischemic stroke: A multi-city case-crossover study in China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 260:113776. [PMID: 31962264 DOI: 10.1016/j.envpol.2019.113776] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/12/2019] [Accepted: 12/08/2019] [Indexed: 06/10/2023]
Abstract
This study aims to examine the association between short-term exposures to PM1, PM2.5 and PM10 (particulate matter with aerodynamic diameters ≤1 μm, ≤2.5 μm and ≤10 μm, respectively) and hospital admission for ischemic stroke in China. Daily counts of hospital admission for ischemic stroke were collected in 5 hospitals in China during November 2013 to October 2015. Daily concentrations of PM1, PM2.5 and PM10 were collected in 5 cities where the hospitals were located. A time-stratified case-crossover design was used to examine the hospital-specific PM-ischemic stroke association after controlling for potential confounders. Then the effect estimates were pooled using a random-effect meta-analysis. A total of 68,122 hospital admissions for ischemic stroke were identified from 5 hospitals during the study period. The pooled results showed that exposures to PM1, PM2.5 and PM10 were significantly associated with increased hospital admission for ischemic stroke on the current day and previous 1 day. The RRs (relative risk associated with per 10 μg/m3 increase in each pollutant) and 95%CIs (confidence intervals) for the cumulative effects of PM1, PM2.5 and PM10 on ischemic stroke during lag 0-1 days were 1.014 (1.005, 1.0023), 1.007 (1.000, 1.014) and 1.005 (1.001, 1.009), respectively. In total, 3.5%, 3.6% and 4.1% of hospital admissions for ischemic stroke could be attributable to PM1, PM2.5 and PM10, respectively. Exposures to ambient PM1, PM2.5 and PM10 pollution showed acute adverse effects on hospital admission for ischemic stroke. The health effects of PM1 should be considered by policy-makers.
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Affiliation(s)
- Lijun Chen
- Information Engineering College, Hubei University of Chinese Medicine, Wuhan, Hubei, China
| | - Yongming Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China.
| | - Wenyi Zhang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Gongbo Chen
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Peng Lu
- Department of Epidemiology, School of Public Health and Management, Binzhou Medical University, Yantai, Shandong, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Mashni SK, O'Neal CR, Abner E, Lee J, Fraser JF. Time Intervals for Direct Versus Transfer Cases of Thrombectomy for Stroke in a Primarily Rural System of Care. J Stroke Cerebrovasc Dis 2020; 29:104689. [PMID: 32151476 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/27/2019] [Accepted: 01/21/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Early treatment is the key to a successful recovery for ischemic stroke patients. From time of onset, a patient's chances of permanent disability only increase until they can receive reperfusion intervention. OBJECTIVE We sought to identify potential delays that occur during evaluation and treatment of patients in a rural regional health system. METHODS We conducted a single-center retrospective review of all patients that arrived at our comprehensive stroke center (CSC) between July 2011 and March 2017, and received thrombectomy, with or without prior treatment with intravenous recombinant tissue plasminogen activator. RESULTS One hundred and fifty-four patients met our criteria for inclusion. Patients were divided into 2 groups: Direct (patients brought to our CSC from scene) and Transfer (patients taken to an outside hospital then transferred to our CSC). The median time to CSC for Direct patients was 82 (range: 15-863) minutes after onset of symptoms, compared to 237 (range: 98-1215) minutes for the Transfer group. The median time for Transfer patients to reach an outside hospital was 74 (range: 5-840) minutes, with an additional average time of 90 minutes in the outside hospital prior to transferred to our CSC. CONCLUSIONS Based on our findings, patients brought directly to our CSC saved a significant amount of time, which may improve functional outcomes. Both groups (Direct and Transfer) spent a similar amount of time between last known normal and emergency medical services arrival, highlighting the need for increased awareness among the public to activate the stroke system of care.
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Affiliation(s)
| | - Charles R O'Neal
- Kentucky Board of Emergency Medical Services, Lexington, Kentucky
| | - Erin Abner
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky
| | - Jessica Lee
- Department of Neurology, University of Kentucky, Lexington, Kentucky
| | - Justin F Fraser
- Department of Neurology, University of Kentucky, Lexington, Kentucky; Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky; Department of Neuroscience, University of Kentucky, Lexington, Kentucky; Department of Radiology, University of Kentucky, Lexington, Kentucky; Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, Kentucky.
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21
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Niklasson A, Herlitz J, Jood K. Socioeconomic disparities in prehospital stroke care. Scand J Trauma Resusc Emerg Med 2019; 27:53. [PMID: 31046804 PMCID: PMC6498576 DOI: 10.1186/s13049-019-0630-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 04/17/2019] [Indexed: 12/14/2022] Open
Abstract
Background and purpose Recent studies have revealed socioeconomic disparities in stroke outcomes. Here, we investigated whether prehospital stroke care differs with respect to socioeconomic status (SES). Methods Consecutive stroke and TIA patients (n = 3006) admitted to stroke units at Sahlgrenska University Hospital, Gothenburg, Sweden, from 1 November 2014 to 31 July 2016, were included. Data on prehospital care were obtained from a local stroke register. Socioeconomic status was classified according to the average level of income and education within each patient’s neighbourhood (postcode area). Results The median system delay from calling the emergency medical communication centre (EMCC) to start of brain computed tomography on hospital arrival was 3 h 47 min (95% confidence interval (CI) 3 h 30 min to 4 h 05 min) for patients within the lowest SES tertile and 3 h 17 min (95% CI 3 h 00 min to 3 h 37 min) for the highest tertile (p < 0.05). Patients with a lower SES were less likely to receive the highest priority in the ambulance (p < 0.05) and had lower rates of prehospital recognition of stroke/TIA (p < 0.05) than those with a high SES. No inequities were found concerning EMCC prioritisation or the probability of ambulance transport. Conclusions We found socioeconomic inequities in prehospital stroke care which could affect the efficacy of acute stroke treatment. The ambulance nurses’ ability to recognise stroke/TIA may partly explain the observed inequities.
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Affiliation(s)
- Amanda Niklasson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg, Blå Stråket 7, plan 3, SE-413 45, Gothenburg, Sweden.
| | - Johan Herlitz
- PreHospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Katarina Jood
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg, Blå Stråket 7, plan 3, SE-413 45, Gothenburg, Sweden
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22
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Late Hospital Arrival for Thrombolysis after Stroke in Southern Portugal: Who Is at Risk? J Stroke Cerebrovasc Dis 2019; 28:900-905. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/09/2018] [Accepted: 12/08/2018] [Indexed: 11/23/2022] Open
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Pulvers JN, Watson JDG. If Time Is Brain Where Is the Improvement in Prehospital Time after Stroke? Front Neurol 2017. [PMID: 29209269 DOI: 10.3389/fneur.2017.00617/full] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Despite the availability of thrombolytic and endovascular therapy for acute ischemic stroke, many patients are ineligible due to delayed hospital arrival. The identification of factors related to either early or delayed hospital arrival may reveal potential targets of intervention to reduce prehospital delay and improve access to time-critical thrombolysis and clot retrieval therapy. Here, we have reviewed studies reporting on factors associated with either early or delayed hospital arrival after stroke, together with an analysis of stroke onset to hospital arrival times. Much effort in the stroke treatment community has been devoted to reducing door-to-needle times with encouraging improvements. However, this review has revealed that the median onset-to-door times and the percentage of stroke patients arriving before the logistically critical 3 h have shown little improvement in the past two decades. Major factors affecting prehospital time were related to emergency medical pathways, stroke symptomatology, patient and bystander behavior, patient health characteristics, and stroke treatment awareness. Interventions addressing these factors may prove effective in reducing prehospital delay, allowing prompt diagnosis, which in turn may increase the rates and/or efficacy of acute treatments such as thrombolysis and clot retrieval therapy and thereby improve stroke outcomes.
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Affiliation(s)
- Jeremy N Pulvers
- Sydney Adventist Hospital Clinical School, Sydney Medical School, The University of Sydney, Wahroonga, NSW, Australia
| | - John D G Watson
- Sydney Adventist Hospital Clinical School, Sydney Medical School, The University of Sydney, Wahroonga, NSW, Australia
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24
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Pulvers JN, Watson JDG. If Time Is Brain Where Is the Improvement in Prehospital Time after Stroke? Front Neurol 2017; 8:617. [PMID: 29209269 PMCID: PMC5701972 DOI: 10.3389/fneur.2017.00617] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/06/2017] [Indexed: 01/19/2023] Open
Abstract
Despite the availability of thrombolytic and endovascular therapy for acute ischemic stroke, many patients are ineligible due to delayed hospital arrival. The identification of factors related to either early or delayed hospital arrival may reveal potential targets of intervention to reduce prehospital delay and improve access to time-critical thrombolysis and clot retrieval therapy. Here, we have reviewed studies reporting on factors associated with either early or delayed hospital arrival after stroke, together with an analysis of stroke onset to hospital arrival times. Much effort in the stroke treatment community has been devoted to reducing door-to-needle times with encouraging improvements. However, this review has revealed that the median onset-to-door times and the percentage of stroke patients arriving before the logistically critical 3 h have shown little improvement in the past two decades. Major factors affecting prehospital time were related to emergency medical pathways, stroke symptomatology, patient and bystander behavior, patient health characteristics, and stroke treatment awareness. Interventions addressing these factors may prove effective in reducing prehospital delay, allowing prompt diagnosis, which in turn may increase the rates and/or efficacy of acute treatments such as thrombolysis and clot retrieval therapy and thereby improve stroke outcomes.
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Affiliation(s)
- Jeremy N Pulvers
- Sydney Adventist Hospital Clinical School, Sydney Medical School, The University of Sydney, Wahroonga, NSW, Australia
| | - John D G Watson
- Sydney Adventist Hospital Clinical School, Sydney Medical School, The University of Sydney, Wahroonga, NSW, Australia
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Zhou Y, Yang T, Gong Y, Li W, Chen Y, Li J, Wang M, Yin X, Hu B, Lu Z. Pre-hospital Delay after Acute Ischemic Stroke in Central Urban China: Prevalence and Risk Factors. Mol Neurobiol 2016; 54:3007-3016. [PMID: 27032390 DOI: 10.1007/s12035-016-9750-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 01/26/2016] [Indexed: 11/24/2022]
Abstract
Timely thrombolytic treatment is paramount after acute ischemic stroke (AIS); however, a large proportion of patients experience substantial delays in presentation to hospital. This study evaluates the prevalence and risk factors in pre-hospital delays after AIS in central urban China. AIS patients from 66 hospitals in 13 major cities across Hubei Province, between October 1, 2014 and January 31, 2015 were interviewed and their medical records were reviewed to identify those who suffered pre-hospital delays. Bivariate and multivariate analyses were undertaken to determine the prevalence rates and the risk factors associated with pre-hospital delays. A total of 1835 patients were included in the analysis, with 69.3 % patients reportedly arrived at hospital 3 or more hours after onset and 55.3 % patients arrived 6 or more hours after onset. Factors associated with increased pre-hospital delays for 3 or more hours were as follows: patient had a history of stroke (odds ratio (OR), 1.319, P = 0.028), onset location was at home (OR, 1.573, P = 0.002), and patients rather than someone else noticed the symptom onset first (OR, 1.711; P < 0.001). In contrast, knowing someone who had suffered a stroke, considering any kind of the symptoms as severe, transferring from a community-based hospital factors, calling emergency number (120), and shorter distance from the onset place to the first hospital were independently associated with decreased pre-hospital delays. These findings indicate that pre-hospital delays after AIS are common in urban central China, and future intervention programs should be focused on public awareness of stroke and appropriate response.
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Affiliation(s)
- Yanfeng Zhou
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tingting Yang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wenzhen Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yawen Chen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jing Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Mengdie Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- The Stroke Quality Control Center of Hubei Province, Wuhan, 430030, China.
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Mellon L, Doyle F, Williams D, Brewer L, Hall P, Hickey A. Patient behaviour at the time of stroke onset: a cross-sectional survey of patient response to stroke symptoms. Emerg Med J 2016; 33:396-402. [PMID: 26781460 DOI: 10.1136/emermed-2015-204806] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 12/22/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Revascularisation treatment with thrombolysis must be initiated within 4.5 h following ischaemic stroke symptom onset. Despite its proven benefits, thrombolysis therapy is underused, with patient delay in presenting to hospital with symptoms identified as the leading barrier. This study aimed to examine help-seeking behaviour at stroke onset, in order to understand delays in accessing acute medical care for stroke symptoms. METHODS 149 consecutive patients hospitalised with ischaemic stroke were interviewed at 72 h poststroke with the Stroke Awareness Questionnaire and the Response to Symptoms Questionnaire. RESULTS Sixty per cent of stroke cases presented to the ED within 3.5 h of stroke onset. Knowledge of stroke symptoms and risk factors was poor, with 40% unable to correctly define a stroke. Bystander recognition of symptoms (p=0.03) and bystander initiation of Emergency Medical Services was associated with ED presentation within 3.5 h (p=0.03). CONCLUSIONS This study provides insights into patient response when a stroke occurs, with the presence and action of others highlighted as critical in fast response to stroke symptoms. Knowledge of stroke warning signs and risk factors was low among stroke survivors. Findings highlight the complexity of changing help-seeking behaviour during stroke onset, and provide directions for public education efforts to reduce prehospital delay.
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Affiliation(s)
- L Mellon
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - F Doyle
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - L Brewer
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P Hall
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
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28
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Yang H, Zhang J, Xie J, Yang C, Dong X, Gong Y, Cao S, Yin X, Wang Z, Lu Z. Factors influencing pre-hospital delay among acute ischemic stroke patients in the midlands of China. Int J Cardiol 2014; 172:533-4. [PMID: 24485609 DOI: 10.1016/j.ijcard.2014.01.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Huajie Yang
- The Affiliated Liyuan Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430077, China
| | - Juan Zhang
- The Affiliated Liyuan Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430077, China; School of Public Health of Shan Xi Medical University, Taiyuan 030001, China
| | - Jun Xie
- The Affiliated Liyuan Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430077, China
| | - Chen Yang
- School of Public Health of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiaoxin Dong
- School of Public Health of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yanhong Gong
- School of Public Health of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shiyi Cao
- School of Public Health of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiaoxv Yin
- School of Public Health of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhihong Wang
- The Affiliated Liyuan Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430077, China.
| | - Zuxun Lu
- School of Public Health of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China.
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Vidale S, Beghi E, Gerardi F, De Piazza C, Proserpio S, Arnaboldi M, Bezzi G, Bono G, Grampa G, Guidotti M, Perrone P, Porazzi D, Zarcone D, Zoli A, Agostoni E. Time to hospital admission and start of treatment in patients with ischemic stroke in northern Italy and predictors of delay. Eur Neurol 2013; 70:349-55. [PMID: 24296825 DOI: 10.1159/000353300] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 05/26/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Early treatment (i.e. thrombolysis) is crucial for a successful care of ischemic stroke. In the management of stroke, two phases are crucial: the pre-hospital and the in-hospital interval. This work investigated factors influencing pre- and in-hospital delay in a large geographic area of Northern Italy. METHODS Enrolled were patients presenting with ischemic stroke in four administrative districts of Northern Italy (Como, Lecco, Sondrio and Varese) over a 4-month period. Pre-hospital time and in-hospital time with single management steps were recorded prospectively. Age, gender, recruiting hospital, EMS transport and triage codes, clinical severity and thrombolytic treatment were also recorded. Univariate and multivariate analysis of factors predicting pre- and in-hospital delay were performed. RESULTS Median pre-hospital time and in-hospital time were, respectively, 120 min (interquartile range, IQR 62-271) and 150 min (IQR 80-214). Pre-hospital time was halved in patients hospitalized via EMS (p<0.001) and clinically more severe (p<0.001). At multivariate analysis, transport code was associated with delay at any time (p<0.05). CONCLUSIONS EMS use and transport code predicted treatment delay in patients with ischemic stroke. A more intensive use of EMS and high urgency codes could help increase the number of stroke patients treated appropriately.
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Affiliation(s)
- Simone Vidale
- Neurological Department, Sant'Anna Hospital, Como, Italy
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Tekle WG, Chaudhry SA, Hassan AE, Peacock JM, Lakshminarayan K, Tsai A, Luepker R, Anderson DC, Qureshi AI. Utilization of intravenous thrombolysis in 3-4.5 hours: analysis of the Minnesota stroke registry. Cerebrovasc Dis 2012; 34:400-5. [PMID: 23221276 DOI: 10.1159/000343504] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 09/14/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The American Heart Association and the American Stroke Association recommend intravenous (IV) thrombolysis up to 4.5 h from acute ischemic stroke symptom onset based on its proven benefit in improving patient outcomes. We analyzed data from the Minnesota Stroke Registry to assess the rates of IV thrombolytic utilization and the process of care in this expanded window. METHODS We identified patients who had received IV recombinant tissue plasminogen activator (rt-PA) at any of the 19 participating hospitals from January 1, 2008 till December 31, 2010. Treatment groups were those actually treated by IV rt-PA in 0-3 h and those treated by IV rt-PA in 3-4.5 h. Duration from symptom onset to arrival in the emergency department (ED) was dichotomized to cohorts of 0-2 and 2-3.5 h. We determined the overall utilization of IV rt-PA in the expanded window and calculated door-to-needle times for the two treatment windows. We also ascertained the rates of symptomatic intracerebral hemorrhage between the two treatment groups. RESULTS Out of the total 519 patients who received IV rt-PA for acute ischemic stroke, 433 (83%) were treated within 0-3 h and 86 (17%) within 3-4.5 h. Of all the patients who received IV rt-PA within 3-4.5 h, 45% arrived at the ED within 2 h of symptom onset. Median door-to-needle time for the 0- to 3-hour window was 74.5 min [interquartile range (IQR) 57-90] and 54 min (IQR 43.5-70.5) for the 3- to 4.5-hour window. Based on arrival time to the ED, door-to-needle time of ≤60 min was achieved by only 31% (142/458) of patients who arrived within 0-2 h of their symptom onset compared to 61% (37/61) of those who arrived at the ED within 2-3.5 h of their symptom onset. Fifty-nine (14%) patients in the 0- to 3-hour group and 17 (20%) patients in the 3- to 4.5-hour group received a combination of IV rt-PA and endovascular treatments. Among patients with documented admission National Institutes of Health Stroke Scale scores, the values (median with IQR) were different between the 0- to 3- and the 3- to 4.5-hour group, i.e. 10 (IQR 5-18) and 7 (IQR 4-14), respectively. CONCLUSION Patients who received IV rt-PA within the 3- to 4.5-hour window comprised 17% of all IV rt-PA cases treated in the Minnesota Stroke Registry hospitals after the new guidelines recommended a time window expansion. Almost half of these patients would have qualified for treatment within the 0- to 3-hour window as they presented within 0-2 h of symptom onset. Patients arriving 2-3.5 h after symptom onset received thrombolysis on average 20 min faster than patients arriving within 2 h of symptom onset.
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Affiliation(s)
- Wondwossen G Tekle
- Zeenat Qureshi Stroke Research Center, University of Minnesota Medical Center, Minneapolis, MN 55455,USA.
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