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Sheng Z, Kuang J, Yang L, Wang G, Gu C, Qi Y, Wang R, Han Y, Li J, Wang X. Predictive models for delay in medical decision-making among older patients with acute ischemic stroke: a comparative study using logistic regression analysis and lightGBM algorithm. BMC Public Health 2024; 24:1413. [PMID: 38802838 PMCID: PMC11129384 DOI: 10.1186/s12889-024-18855-6] [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: 01/21/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE To explore the factors affecting delayed medical decision-making in older patients with acute ischemic stroke (AIS) using logistic regression analysis and the Light Gradient Boosting Machine (LightGBM) algorithm, and compare the two predictive models. METHODS A cross-sectional study was conducted among 309 older patients aged ≥ 60 who underwent AIS. Demographic characteristics, stroke onset characteristics, previous stroke knowledge level, health literacy, and social network were recorded. These data were separately inputted into logistic regression analysis and the LightGBM algorithm to build the predictive models for delay in medical decision-making among older patients with AIS. Five parameters of Accuracy, Recall, F1 Score, AUC and Precision were compared between the two models. RESULTS The medical decision-making delay rate in older patients with AIS was 74.76%. The factors affecting medical decision-making delay, identified through logistic regression and LightGBM algorithm, were as follows: stroke severity, stroke recognition, previous stroke knowledge, health literacy, social network (common factors), mode of onset (logistic regression model only), and reaction from others (LightGBM algorithm only). The LightGBM model demonstrated the more superior performance, achieving the higher AUC of 0.909. CONCLUSIONS This study used advanced LightGBM algorithm to enable early identification of delay in medical decision-making groups in the older patients with AIS. The identified influencing factors can provide critical insights for the development of early prevention and intervention strategies to reduce delay in medical decisions-making among older patients with AIS and promote patients' health. The LightGBM algorithm is the optimal model for predicting the delay in medical decision-making among older patients with AIS.
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Affiliation(s)
- Zhenwen Sheng
- Shandong Xiehe University, Jinan City, Shandong Province, China
| | - Jinke Kuang
- Shandong Xiehe University, Jinan City, Shandong Province, China
| | - Li Yang
- Qingdao University, Qingdao City, Shandong Province, China.
| | - Guiyun Wang
- Shandong Xiehe University, Jinan City, Shandong Province, China
| | - Cuihong Gu
- Shandong Xiehe University, Jinan City, Shandong Province, China
| | - Yanxia Qi
- Shandong Xiehe University, Jinan City, Shandong Province, China
| | - Ruowei Wang
- Shandong Xiehe University, Jinan City, Shandong Province, China
| | - Yuehua Han
- Shandong Xiehe University, Jinan City, Shandong Province, China
| | - Jiaojiao Li
- Shandong Xiehe University, Jinan City, Shandong Province, China
| | - Xia Wang
- Qilu Hospital of Shandong University, Jinan City, Shandong Province, China
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Tworek K, Tomaszewska A, Owecka B, Fryska Z, Marcinkowski JT, Owecki M. Non-compliance with medical recommendations results in delayed hospitalization and poorer prognosis in patients with cerebral ischemic stroke in Poland: Non-compliance effects on post-ischemic stroke prognosis. J Stroke Cerebrovasc Dis 2024; 33:107465. [PMID: 37949030 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/06/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES This study aimed to reveal and analyze the causes of delays in reaching the hospital of patients with cerebral ischemic stroke and to assess their clinical picture. MATERIAL AND METHODS The study group included 161 patients with stroke, who reported to the hospital beyond the thrombolytic treatment therapeutic window. The control group consisted of 85 patients recruited consecutively with stroke who received thrombolytic treatment per eligibility criteria. Laboratory and medical imaging tests essential for neurological condition assessment were conducted in the study group. Control group research was based on retrospective analysis of medical records. RESULTS The rate of deaths during hospitalization was lower in the control group (4.7%) compared to the study group (14.9%). In the study group, more patients (16.8%) admitted to non-compliance with medical recommendations than in the control group (5.9%). There were no statistically significant differences in nicotinism and alcohol dependence syndrome frequency between both groups. CONCLUSIONS Based on each group inclusion criteria, a lower mortality rate in the control group indicates a crucial role of the therapeutic window in cerebral stroke treatment. Analysis of reasons for delay points out that efficient prophylaxis is the education of patients with stroke risk factors and their families.
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Affiliation(s)
- Karolina Tworek
- Department of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland
| | - Agata Tomaszewska
- Students Research Circle of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland
| | - Barbara Owecka
- Students Research Circle of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland
| | - Zuzanna Fryska
- Students Research Circle of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland
| | - Jerzy T Marcinkowski
- Department of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland
| | - Maciej Owecki
- Department of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland.
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Anees A, Panicker P, Iype T, Sreelekha KR. Assessment of onset-to-door time in acute ischemic stroke and factors associated with delay at a tertiary care center in South India. J Neurosci Rural Pract 2024; 15:86-94. [PMID: 38476422 PMCID: PMC10927050 DOI: 10.25259/jnrp_325_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/26/2023] [Indexed: 03/14/2024] Open
Abstract
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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Affiliation(s)
- Ashika Anees
- Department of Neurology, Government Medical College Thiruvananthapuram, Kerala, India
| | - Praveen Panicker
- Department of Neurology, Government Medical College Thiruvananthapuram, Kerala, India
| | - Thomas Iype
- Department of Neurology, Government Medical College Thiruvananthapuram, Kerala, India
| | - K. R. Sreelekha
- Department of Community Medicine, Government Medical College Thiruvananthapuram, Kerala, India
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Amalia L. Factors Affecting the Delay of intravenous Thrombolysis in Hyperacute Ischemic Stroke Patients: A Single Centre Study. Int J Gen Med 2023; 16:2157-2163. [PMID: 37284035 PMCID: PMC10239640 DOI: 10.2147/ijgm.s412262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Intravenous thrombolysis with r-tPA is the gold standard procedure in managing acute ischemic stroke recommended by the World Stroke Association, which is performed by injecting the drug r-tPA (Alteplase) intravenously. Generally, the preparation time to achieve thrombolysis is divided into pre-hospital and in-hospital. If this time can be shortened, the efficacy of thrombolysis can be increased. This study aims to determine the factors that can affect the delay in thrombolysis. Methods This is an analytic observational study with a retrospective cohort design in ischemic stroke confirmed by a neurologist at the neurology emergency unit of Hasan Sadikin Hospital (RSHS) from January 2021 to December 2021 and divided into two groups, delay and non-delay thrombolysis. A logistic regression test was performed to determine the independent predictor of delayed thrombolysis. Results There were 141 patients with an ischemic stroke diagnosis confirmed by a neurologist at the neurological emergency unit at Hasan Sadikin Hospital (RSHS) from January 2021 to December 2021. A total of 118 (83.69%) patients were included in the "delay" category, while 23 (16.31%) patients were included in the "non-delay" category. Patients included in the "delay" category had an average age of 58.29+11.19 years with a male-to-female sex ratio of 57%, while patients included in the "non-delay" category had an average age of 55.57+15.55 years with a male-to-female sex ratio of 66%. The NIHSS admission score was a significant risk factor for delayed thrombolysis. Through multiple logistic regression, it was found that age, onset, female gender, NIHSS admission score, and NIHSS discharge score were independent predictors of delayed thrombolysis. However, all of them were not statistically significant. Conclusion Gender, risk factors for dyslipidemia, and arrival onset are independent predictors of delayed thrombolysis. Prehospital factors contribute relatively more to the delay in thrombolytic action.
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Affiliation(s)
- Lisda Amalia
- Department of Neurology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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Zhang B, Sun Q, Lv Y, Sun T, Zhao W, Yan R, Guo Y. Influencing factors for decision-making delay in seeking medical care among acute ischemic stroke patients in rural areas. PATIENT EDUCATION AND COUNSELING 2023; 108:107614. [PMID: 36603468 DOI: 10.1016/j.pec.2022.107614] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/10/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To explore the factors influencing decision-making delay in seeking medical care for patients with acute ischemic stroke (AIS) in rural areas. METHODS From September to December 2021, we conducted a questionnaire survey of 260 patients with AIS who were hospitalized in the neurology departments of four county-level hospitals in Daqing. A decision-tree and logistic regression model was used to investigate the elements contributing to decision-making delays. RESULTS This study found that the decision-making delay rate for rural patients with AIS was 71.5%. The results of the univariate analysis showed that factors associated with decision-making delay included educational level, National Institute of Health stroke scale (NIHSS) score, self-assessed health, monthly income, social support, attitude toward medical help-seeking, health belief, and family dynamics (P < 0.05). Further, we combined logistic regression (LR) and decision-tree (DT) models for multivariate analysis, and finally obtained five factors affecting decision-making delay in AIS patients in rural areas: disease severity, health belief, monthly income (common factors), educational level (only DT model), and social support (only LR model). CONCLUSIONS This study found that a few variables, including disease severity, educational level, monthly income, health belief, and social support, affected rural AIS patients' decision-making delay in seeking medical care. PRACTICE IMPLICATIONS To achieve the goal of reducing decision-delay and increasing thrombolysis rate, this study thoroughly examined the influencing factors of decision-making delay in seeking medical care of rural AIS patients from various angles. This analysis provides guidance for medical and healthcare professionals on how to best provide future health education for the high-risk population for stroke in rural areas.
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Affiliation(s)
- Boyu Zhang
- Department of nursing, Harbin Medical University, Harbin, China
| | - Qiuxue Sun
- Department of nursing, Harbin Medical University, Harbin, China
| | - Yumei Lv
- Department of nursing, Harbin Medical University, Harbin, China.
| | - Ting Sun
- Department of nursing, Harbin Medical University, Harbin, China
| | - Wanyue Zhao
- Department of nursing, Harbin Medical University, Harbin, China
| | - Rui Yan
- Department of nursing, Harbin Medical University, Harbin, China
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BOLATTÜRK ÖF. Factors affecting the presentation time of patients with acute stroke to hospital and level of awareness of thrombolytic therapy. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2023. [DOI: 10.32322/jhsm.1177076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction
In this study, it was aimed to reveal the factors affecting the time of presentation of patients with acute stroke to the hospital, determine the rates of benefiting from thrombolytic therapy and assess the thrombolytic therapy awareness of patients.
Materials and Methods
276 patients with acute stroke were included in our study. Standard structured questionnaire was administered to the patients. Patients were asked about the time of onset of stroke, age, place of residence, level of education, whether they received thrombolytic therapy, what was done as the first intervention, and whether they had information about thrombolytic therapy. Stroke severity was also evaluated by applying the National Institutes of Health Stroke Scale (NIHSS) to the patients.
Results
Of the patients included in the study, 218 (79%) had ischemic stroke, 26 (9.4%) had intracerebral hemorrhage and 32 (11.6%) had TIA. The mean NIHH score of the patients was 6.7±6.2. Stroke onset time was mainly between 18.00-24.00 with a rate of 28.3%. It was understood that 83.1% of the patients came to the emergency department by ambulance and 16.9% came by their own vehicle. When the groups of patients who received and did not receive thrombolytic therapy were compared, no significant difference was found between who the patient lived with at home and the groups of the level of education. Statistical significance was found with symptom onset time (p
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Potisopha W, Vuckovic KM, DeVon HA, Park CG, Phutthikhamin N, Hershberger PE. Decision Delay Is a Significant Contributor to Prehospital Delay for Stroke Symptoms. West J Nurs Res 2023; 45:55-66. [PMID: 35711105 DOI: 10.1177/01939459221105827] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prehospital delay after stroke symptom onset is a primary barrier to eligibility for reperfusion therapies. Decision delay is an understudied contributor to prehospital delay. We aimed to explore decision delay as a component of prehospital delay. For this correlational study, 170 Thai acute stroke patients were interviewed to explore their treatment-seeking decision factors: prior stroke knowledge, onset context, and cognitive, emotional, and behavioral factors. Participants' mean age was 61.2 years, and 46% were women. Median decision delay and prehospital delay times were 120 and 372 minutes. Decision delay represented 49% of prehospital delays. Factors shortening decision delay were atrial fibrillation, prior stroke knowledge, perceived cause of symptoms as stroke, perceived severity of symptoms, and advice from bystanders to seek treatment. In contrast, seeking support from others and self-treatment affected prolonged decision delay. Shortening decision delay, often under the patient or bystander control, can reduce overall prehospital delay.
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Affiliation(s)
- Wiphawadee Potisopha
- Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand.,North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Karen M Vuckovic
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA.,College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Holli A DeVon
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Chang G Park
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | | | - Patricia E Hershberger
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA.,College of Medicine, University of Illinois Chicago, Chicago, IL, USA
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Kuang J, Zhu X, Yang L, Gao Z, Wei X, Zhou K, Xu M. Factors influencing alertness to premonitory symptoms in stroke patients with pre-hospital delay. Public Health Nurs 2022; 39:1204-1212. [PMID: 35714655 DOI: 10.1111/phn.13108] [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: 10/18/2021] [Revised: 05/01/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose was to explore the alertness of premonitory symptoms in stroke patients with prehospital delay, and to analyze the influencing factors. DESIGN AND SAMPLE A cross-sectional study using the convenience sampling method was conducted in the neurology department of a general hospital between November 2018 and July 2019. A total of 352 stroke patients were participated in the survey. MEASURES A hierarchical multiple regression was performed to analyze the factors related to the alertness of premonitory symptoms (0-9 scores) in stroke patients with prehospital delay. RESULTS The alertness score was 6.53 ± 2.377. The lowest score of 0.55 ± 0.498 was for "Continuous yawning occurs continuously despite no tiredness or lack of sleep is okay, and need not be treated." The hierarchical regression results revealed that symptom onset, symptom change before admission, knowledge, social support were the influencing factors delaying the alertness of premonitory symptoms. Knowledge and support from friends could improve the alertness, while support from family and other support had a notable negative impact. CONCLUSIONS Stroke patients need to be more alert toward premonitory symptoms. This alertness is related to stroke knowledge and social support. Nurses should formulate interventions and advise stroke patients to improve their stroke knowledge and expand their social network.
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Affiliation(s)
- Jinke Kuang
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Xuemei Zhu
- School of Nursing, Harbin Medical University/The 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Li Yang
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Zihan Gao
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Xiao Wei
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Kexin Zhou
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Mengfan Xu
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
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Bakke I, Lund CG, Carlsson M, Salvesen R, Normann B. Barriers to and facilitators for making emergency calls - a qualitative interview study of stroke patients and witnesses. J Stroke Cerebrovasc Dis 2022; 31:106734. [PMID: 36037678 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/14/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Early access to hospital for diagnosis and treatment is strongly recommended for patients with acute stroke. Unfortunately, prehospital delay frequently occurs. The aim of the current study was to gain in-depth insight into patient experience and behavior in the prehospital phase of a stroke. METHODS We conducted qualitative interviews with a purposive sample of 11 patients and six witnesses within four weeks post stroke. The interviews were audio recorded, transcribed, and analyzed utilizing Systematic Text Condensation. RESULTS The material was classified according to two main categories each containing three subgroups. The first category contained the diversity of sudden changes that all participants noticed. The subgroups were confusing functional changes, distinct bodily changes and witnesses' observations of abnormal behavior or signs. The second category was delaying and facilitating factors. To trivialize or deny stroke symptoms, or having a high threshold for contacting emergency services, led to time delay. Factors facilitating early contact were severe stroke symptoms, awareness of the consequences of stroke or a witness standing by when the stroke occurred. CONCLUSIONS Prehospital delays involved interrelated elements: (1) Difficulties in recognition of a stroke when symptoms were mild, odd and/or puzzling; (2) Recognition of a stroke or need for medical assistance were facilitated by interaction/communication; (3) High threshold for calling emergency medical services, except when symptoms were severe. The findings may be helpful in planning future public stroke campaigns and in education and training programs for health personnel.
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Affiliation(s)
- Ida Bakke
- Patient Safety Unit, Nordland Hospital Trust, Bodø, Norway; Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
| | | | - Maria Carlsson
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Department of Neurology, Nordland Hospital Trust, Bodø, Norway
| | - Rolf Salvesen
- Department of Neurology, Nordland Hospital Trust, Bodø, Norway
| | - Britt Normann
- Faculty of Nursing and Health Science, Nord University, Bodø, Norway; Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway
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Duvekot MH, Kerkhoff H, Venema E, Bos HW, Smeekes D, Buijck BI, Rozeman AD, Moudrous W, Vermeij FH, Nijeholt GJLÀ, Jan van Doormaal P, van Es AC, van der Lugt PA, Dippel PD, Roozenbeek B. Medical Attention Seeking by Suspected Stroke Patients: Emergency Medical Services or General Practitioner? Clin Neurol Neurosurg 2022; 218:107297. [DOI: 10.1016/j.clineuro.2022.107297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/24/2022] [Accepted: 05/14/2022] [Indexed: 11/28/2022]
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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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Bull Iversen A, Paaske Johnsen S, Christensen B, Bondo Christensen M, Andersen G. The impact of a Danish stroke campaign: A cross-sectional study. Acta Neurol Scand 2022; 145:102-110. [PMID: 34523120 DOI: 10.1111/ane.13531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the impact of the Danish stroke campaign, 1 year after initiation. MATERIALS & METHODS The campaign ran in various media during 2019-2020. We performed a two-centre, repeated cross-sectional study in 2018 (before campaign) and again in 2020 based on data from structured interviews of patients and bystanders, medical records and the Danish Stroke Registry. Primary outcomes were patient delay and system delay. Patient delay is defined as the time from symptom onset until the first contact to a healthcare professional, whereas system delay is the time from this contact until arrival at the stroke centre. Secondary outcomes were primary emergency medical services (EMS) contact, arrival at a stroke centre within 3 h of symptom onset, initiation of reperfusion therapy and knowledge of ≥2 core symptoms of stroke. RESULTS We included 852 patients with stroke or transient ischemic attack. Patient delay and system delay were a median of 166 min and 96 min before the campaign and were non-significantly reduced by 16 min (95% CI -128 to 97) and 7 min (95% CI -21 to 6) in the second period. We found no significant differences in the clinical outcomes. The knowledge of ≥2 core symptoms increased from 22% to 30% (OR 1.63; 95% CI 1.15 to 2.30) in patients and from 53% to 65% (OR 1.81; 95% CI 1.24 to 2.64) in bystanders. CONCLUSION Patient delay, system delay and clinical outcomes remained relatively unchanged. However, the knowledge of core symptoms had improved 1 year after campaign initiation.
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Affiliation(s)
- Ane Bull Iversen
- Department of Clinical Medicine—Neurology Aarhus University Aarhus N Denmark
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research Department of Clinical Medicine Aalborg University and Aalborg University Hospital Aalborg Denmark
| | - Bo Christensen
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Grethe Andersen
- Department of Clinical Medicine—Neurology Aarhus University Aarhus N Denmark
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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. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Iversen AB, Johnsen SP, Blauenfeldt RA, Gude MF, Dalby RB, Christensen B, Andersen G, Christensen MB. Help-seeking behaviour and subsequent patient and system delays in stroke. Acta Neurol Scand 2021; 144:524-534. [PMID: 34124770 DOI: 10.1111/ane.13484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Prehospital delay is the main reason why only a limited number of stroke patients receive reperfusion therapy. We aimed to investigate help-seeking behaviour in patients and bystanders after onset of stroke and subsequent patient and system delay. MATERIALS & METHODS We conducted a cross-sectional study of 332 patients with stroke. We performed structured interviews and used data from the medical records and the Danish Stroke Registry. Primary outcomes were patient delay and system delay. RESULTS The median patient delay was 280 min, and the median system delay was 97 min. For a patient delay of <3 h, an additional non-significant system delay of median 30 min was seen for a first contact to a general practitioner (GP), and an additional significant delay of median 490 min was seen for the small group of patients with a first contact to 'other' healthcare professionals compared to the Emergency Medical Services (EMS). For a patient delay of more than 3 h, an additional system delay of median 78 min was found when the first contact was directed to the out-of-hours primary care (OOH-PC). A total of 17% of patients were admitted to another hospital or department before arrival at the stroke centre; this resulted in a substantially prolonged system delay of a median of 431 min. CONCLUSIONS Patient delay remains the main reason for delayed arrival at the stroke centre. Appropriate help-seeking behaviour and efficient pre-hospital triage are essential for reducing the prehospital delay and increasing the proportion of patients receiving reperfusion therapy.
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Affiliation(s)
- Ane Bull Iversen
- Department of Clinical Medicine – Neurology Aarhus University Aarhus N Denmark
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research Department of Clinical Medicine Aalborg University and Aalborg University Hospital Aalborg Denmark
| | | | - Martin Faurholdt Gude
- Department of Clinical Medicine Pre‐hospital Emergency Medical Services Aarhus University Aarhus N Denmark
| | - Rikke Beese Dalby
- Department of Clinical Medicine – Radiology Aarhus University Hospital Aarhus N Denmark
| | - Bo Christensen
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Grethe Andersen
- Department of Clinical Medicine – Neurology Aarhus University Aarhus N Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
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Cioni G, Canini J. The side effects of the COVID-19 pandemic on key public health elements - How the global emergency has changed the acute management of myocardial infarction and stroke, the network of cancer care, and assistance to frail individuals. ITALIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4081/itjm.2021.1462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a primary health problem globally. In particular, it has caused troubles even to the advanced health systems of Western countrieswho attempted to limit the spread of the infection and manage patients with severe respiratory distress. However, this sudden contingency has had a much higher cost if we also consider the cost of suspending ordinary clinical care or delays in the emergency pathways of non-COVID-19 patients. Furthermore, the policies applied to contain the contagion have exacerbated the socio-economic disparities of the population and isolated fragile patients, making them subject to clinical relapses or aggravation of chronic diseases. For this reason, the various specialist centers have equipped themselves to guarantee an effective therapeutic path. In this brief review, we have outlined some consequent repercussions on the management of acute and chronic cardiovascular and neurovascular diseases and on oncological treatment. In particular, we have described the effects of the current health reorganization on some acute and time-dependent diseases, such as stroke and acute coronary syndromes, in which therapeutic delay is potentially disabling or fatal. Furthermore, we have focused on cancer treatments, whose essential cornerstones are early screening and follow-up. Finally, the suffering of the local health network has led to a lack of continuity of care in fragile patients, such as psychiatric, marginalized, or multiple comorbid patients.
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Sonne A, Egholm S, Elgaard L, Breindahl N, Jensen AH, Eskesen V, Lippert F, Waldorff FB, Lohse N, Rasmussen LS. Symptoms presented during emergency telephone calls for patients with spontaneous subarachnoid haemorrhage. Scand J Trauma Resusc Emerg Med 2021; 29:118. [PMID: 34399811 PMCID: PMC8365904 DOI: 10.1186/s13049-021-00934-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background A spontaneous subarachnoid haemorrhage (SAH) is one of the most critical neurological emergencies a dispatcher can face in an emergency telephone call. No study has yet investigated which symptoms are presented in emergency telephone calls for these patients. We aimed to identify symptoms indicative of SAH and to determine the sensitivity of these and their association (odds ratio, OR) with SAH. Methods This was a nested case–control study based on all telephone calls to the medical dispatch center of Copenhagen Emergency Medical Services in a 4-year time period. Patients with SAH were identified in the Danish National Patient Register; diagnoses were verified by medical record review and their emergency telephone call audio files were extracted. Audio files were replayed, and symptoms extracted in a standardized manner. Audio files of a control group were replayed and assessed as well. Results We included 224 SAH patients and 609 controls. Cardiac arrest and persisting unconsciousness were reported in 5.8% and 14.7% of SAH patients, respectively. The highest sensitivity was found for headache (58.9%), nausea/vomiting (46.9%) and neck pain (32.6%). Among conscious SAH patients these symptoms were found to have the strongest association with SAH (OR 27.0, 8.41 and 34.0, respectively). Inability to stand up, speech difficulty, or sweating were reported in 24.6%, 24.2%, and 22.8%. The most frequent combination of symptoms was headache and nausea/vomiting, which was reported in 41.6% of SAH patients. More than 90% of headaches were severe, but headache was not reported in 29.7% of conscious SAH patients. In these, syncope was described by 49.1% and nausea/vomiting by 37.7%. Conclusion Headache, nausea/vomiting, and neck pain had the highest sensitivity and strongest association with SAH in emergency telephone calls. Unspecific symptoms such as inability to stand up, speech difficulty or sweating were reported in 1 out of 5 calls. Interestingly, 1 in 3 conscious SAH patients did not report headache. Trial registration NCT03980613 (www.clinicaltrials.gov).
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Affiliation(s)
- Asger Sonne
- Department of Anaesthesia, section 6011, Center of Head and Orthopaedics, Rigshospitalet, Inge Lehmanns Vej 6, 2100, Copenhagen, Denmark.
| | - Sarita Egholm
- Department of Anaesthesia, section 6011, Center of Head and Orthopaedics, Rigshospitalet, Inge Lehmanns Vej 6, 2100, Copenhagen, Denmark
| | - Laurits Elgaard
- Department of Anaesthesia, section 6011, Center of Head and Orthopaedics, Rigshospitalet, Inge Lehmanns Vej 6, 2100, Copenhagen, Denmark
| | - Niklas Breindahl
- Department of Anaesthesia, section 6011, Center of Head and Orthopaedics, Rigshospitalet, Inge Lehmanns Vej 6, 2100, Copenhagen, Denmark
| | - Alice Herrlin Jensen
- Department of Anaesthesia, section 6011, Center of Head and Orthopaedics, Rigshospitalet, Inge Lehmanns Vej 6, 2100, Copenhagen, Denmark
| | - Vagn Eskesen
- Department of Neurosurgery, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Frans Boch Waldorff
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Lohse
- Department of Emergency Medicine, Copenhagen University Hospital - Nordsjællands Hospital, Hillerød, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Simon Rasmussen
- Department of Anaesthesia, section 6011, Center of Head and Orthopaedics, Rigshospitalet, Inge Lehmanns Vej 6, 2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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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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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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Nguyen TTM, Kruyt ND, Pierik JGJ, Doggen CJM, van der Lugt P, Ramessersing SAV, Wijers NT, Brouwers PJAM, Wermer MJH, den Hertog HM. Stroke patient's alarm choice: General practitioner or emergency medical services. Acta Neurol Scand 2021; 143:164-170. [PMID: 32885417 PMCID: PMC7821309 DOI: 10.1111/ane.13341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/12/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
Objectives Stroke patients should be treated as soon as possible since the benefit of reperfusion therapies is highly time‐dependent. The proportion of patients eligible for reperfusion therapy is still limited, as many patients do not immediately alarm healthcare providers. The choice of healthcare system entrance influences the time of arrival in the hospital. Therefore, we assessed differences in these choices to obtain insight for strategies to reduce time delays in acute stroke patients. Materials and Methods Patients with suspected acute stroke admitted to the participating hospitals received a questionnaire. We assessed differences between patients who initially alarmed the general practitioner (GP) and patients who directly alarmed the emergency medical services (EMS). Additionally, we assessed regional differences and patient trajectories after medical help was sought. Results We included 163 patients. Most patients alarmed the GP as primary healthcare provider (n = 104; 64%), and median onset‐to‐door times were longer in these patients (466 minutes [IQR 149–1586]) compared to patients directly alarming the EMS (n = 59; 36%) (90 minutes [IQR 45–286]). This was even more pronounced in less densely populated areas. Patients who alarmed the GP first, more often had patient delay >15 minutes, hesitated to burden healthcare providers and underestimated symptomatology. Conclusions Our results showed that patients who alarmed the GP first instead of the EMS differed in several factors that are potentially modifiable. Strategies to achieve reduction of vital prehospital time delays and to improve patient outcome are optimizing public awareness campaigns and GP triage along with adjusting current guidelines by enabling and focusing on immediate involvement of the EMS once acute stroke is suspected.
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Affiliation(s)
- T. Truc My Nguyen
- Department of Neurology Leiden University Medical Centre Leiden The Netherlands
| | - Nyika D. Kruyt
- Department of Neurology Leiden University Medical Centre Leiden The Netherlands
| | - Jorien G. J. Pierik
- Department of Transmural Care Medisch Spectrum Twente Enschede The Netherlands
| | - Carine J. M. Doggen
- Department of Health Technology & Services Research and Faculty of Behavioral, Management and Social Sciences Technical Medical Centre Enschede the Netherlands
- Department of Science Rijnstate Arnhem Arnhem The Netherlands
| | | | | | - Naomi T. Wijers
- Department of Neurology Leiden University Medical Centre Leiden The Netherlands
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20
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Amtoft AC, Danielsen AK, Hornnes N, Kruuse C. A Qualitative Inquiry Into Patient Reported Factors That Influence Time From Stroke Symptom Onset to Hospitalization. J Neurosci Nurs 2021; 53:5-10. [PMID: 33323718 DOI: 10.1097/jnn.0000000000000557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT BACKGROUND: Approximately 50% of Danish stroke patients did not arrive within the 4.5-hour revascularization window in 2018, and only 20% received acute revascularization therapy. Delay in seeking help was a major factor for missing the time window. This study explored patient-reported factors influencing the timing of a decision to seek help. METHODS: We performed a qualitative interview study to explore prehospital help-seeking behavior. Inclusion was guided by a purposive sampling of stroke and transient ischemic attack patients and, if necessary, bystanders. Semistructured explorative interviews with 8 patients and 2 bystanders were audio-recorded, transcribed verbatim, and analyzed via thematic analysis. RESULTS: Analysis yielded 3 main themes: (1) symptom interpretation, (2) barriers and enablers to response, and (3) participant suggested optimization of acute stroke response and awareness. DISCUSSION: Factors associated with prompt action to seek help were either a perception that the symptom indicated a serious illness or a strong emotional response. Patients with recurrent stroke failed to associate symptoms with a new stroke. Having a stroke in unfamiliar surroundings prompted delay in seeking help. Suggestions for optimization included targeted stroke campaigns. CONCLUSION: Response to stroke onset may be driven by perceptions of symptom severity and emotional response rather than the ability to correctly identify symptoms. Stroke education should include the information that new stroke symptoms may be different from the old ones because different parts of the brain may be affected.
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21
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Ungerer MN, Busetto L, Begli NH, Riehle K, Regula J, Gumbinger C. Factors affecting prehospital delay in rural and urban patients with stroke: a prospective survey-based study in Southwest Germany. BMC Neurol 2020; 20:441. [PMID: 33276739 PMCID: PMC7718652 DOI: 10.1186/s12883-020-01999-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/12/2020] [Indexed: 11/15/2022] Open
Abstract
Background Reducing prehospital delay plays an important role in increasing the thrombolysis rate in patients with stroke. Several studies have identified predictors for presentation ≤4.5 h, but few compared these predictors in urban and rural communities. We aimed to identify predictors of timely presentation to the hospital and identify possible differences between the urban and rural populations. Methods From January to June 2017, we conducted a prospective survey of patients with stroke admitted to an urban comprehensive stroke centre (CSC) and a rural primary care centre (PCC). Predictors were identified using binary logistical regression. Predictors and patient characteristics were then compared between the CSC and PCC. Results Overall, 459 patients were included in our study. We identified hesitation before seeking help, awareness of the existence of a time-window, type of admission and having talked about stroke symptoms with friends/relatives who had previously had a stroke as the strongest predictors for presentation to the emergency room ≤4.5 h. Patients admitted to the rural PCC were more hesitant to seek help and less likely to contact emergency services, even though patients had comparable knowledge pertaining to stroke care concepts. Conclusions Patients from rural areas were more likely to be hesitant to seek help and contacted the EMS less frequently, despite similar self-awareness of having a stroke. Educational campaigns should focus on addressing these disparities in rural populations. Affected patients should also be encouraged to talk about their symptoms and take part in educational campaigns.
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Affiliation(s)
- Matthias N Ungerer
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Loraine Busetto
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Nima H Begli
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Katharina Riehle
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Jens Regula
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christoph Gumbinger
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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22
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Kristoffersen ES, Jahr SH, Thommessen B, Rønning OM. Effect of COVID-19 pandemic on stroke admission rates in a Norwegian population. Acta Neurol Scand 2020; 142:632-636. [PMID: 32620027 PMCID: PMC7361547 DOI: 10.1111/ane.13307] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 11/25/2022]
Abstract
Objectives There are concerns that public anxiety around COVID‐19 discourages patients from seeking medical help. The aim of this study was to see how lockdown due to the pandemic affected the number of admissions of acute stroke. Methods All patients discharged from Akershus University Hospital with a diagnosis of transient ischemic attack (TIA) or acute stroke were identified by hospital chart review. January 3 to March 12 was defined as before, and March 13 to April 30 as during lockdown. Results There were 21.8 admissions/week before and 15.0 admissions/week during the lockdown (P < .01). Patients had on average higher NIHSS during the lockdown than before (5.9 vs. 4.2, P = .041). In the multivariable logistic regression model for ischemic stroke (adjusted for sex, age, living alone and NIHSS ≤ 5), there was an increased OR of 2.05 (95% CI 1.10‐3.83, P = .024) for not reaching hospital within 4.5 hours during the lockdown as compared to the period before the lockdown. Conclusion There was a significant reduction in number of admissions for stroke and TIAs during the lockdown due to the COVID‐19 pandemic in Norway.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Department of Neurology Akershus University Hospital Lørenskog Norway
- Department of General Practice University of Oslo Oslo Norway
| | - Silje Holt Jahr
- Department of Neurology Akershus University Hospital Lørenskog Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Bente Thommessen
- Department of Neurology Akershus University Hospital Lørenskog Norway
| | - Ole Morten Rønning
- Department of Neurology Akershus University Hospital Lørenskog Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
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Seo AR, Song H, Lee WJ, Park KN, Moon J, Kim D. Factors Associated with Delay of Emergency Medical Services Activation in Patients with Acute Stroke. J Stroke Cerebrovasc Dis 2020; 30:105426. [PMID: 33161352 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105426] [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: 06/24/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The poor prognosis of acute stroke may be largely attributed to delays in treatment. Emergency medical services (EMS) usage is associated with a significant reduction in the delay in stroke treatment. The aims of this study were to identify factors associated with the delay in EMS activation for patients with acute stroke. METHODS This study was conducted at 26 Fire Safety Centers in five districts of Seoul, Korea. Patients with acute stroke transferred by EMS and admitted to a tertiary referral hospital from January 2014 to December 2018 were enrolled. In this cross-sectional study, the dependent variable was the time from stroke onset to EMS activation time. Patients were divided into two groups, onset-to-alarm time ≤ 30 min and onset-to-alarm time > 30 min, and previously collected patient data were analyzed. We performed logistical regression analyses of characteristics differing significantly between groups. RESULTS Out of 480 patients, 197 (41%) had onset-to-alarm times > 30 min. Significant variables in the logistical analysis were alert mental state (adjusted odds ratio [aOR]: 2.77; 95% confidence interval [CI]: 1.31-6.13), pre-stroke mRS ≥ 2 (aOR: 2.46; 95% CI: 1.26-4.95), onset occurrence at private space (aOR: 2.31; 95% CI: 1.23-4.41), recognizing symptoms between 0 and 8 am (aOR: 2.30; 95% CI: 1.25-4.31), ischemic stroke (aOR: 1.88; 95% CI: 1.04-3.43), and witnessed by others (aOR: 0.32; 95% CI: 0.18-0.55). CONCLUSIONS Delay in EMS activation for acute stroke cases is possibly related to difficult situations to recognize stroke symptoms, such as alert mental state, pre-stroke mRS ≥ 2, onset occurrence at private space, recognizing symptoms between 0 and 8 am, and unwitnessed by others.
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Affiliation(s)
- Ah Ram Seo
- From the Department of Emergency Medical Service, College of Health and Nursing, Kongju National University, Kongju, Korea
| | - Hwan Song
- Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woon Jeong Lee
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyu Nam Park
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jundong Moon
- From the Department of Emergency Medical Service, College of Health and Nursing, Kongju National University, Kongju, Korea.
| | - Daehee Kim
- Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
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Iversen AB, Blauenfeldt RA, Johnsen SP, Sandal BF, Christensen B, Andersen G, Christensen MB. Understanding the seriousness of a stroke is essential for appropriate help-seeking and early arrival at a stroke centre: A cross-sectional study of stroke patients and their bystanders. Eur Stroke J 2020; 5:351-361. [PMID: 33598553 DOI: 10.1177/2396987320945834] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/05/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Only a minority of patients with acute ischaemic stroke receive reperfusion treatment, primarily due to prehospital delay. We aimed to investigate predictors of a primary contact to the emergency medical services, arrival at stroke centre within 3 h of symptom onset and initiation of reperfusion therapy in patients with acute stroke. Patients and methods We conducted a cross-sectional study of consecutive patients with acute ischaemic stroke, intracerebral haemorrhage or transient ischaemic attack. Structured interviews of patients and bystanders were performed and combined with clinical information from the Danish Stroke Registry. Eligible patients were aged ≥18 years and were independent in activities of daily living before the stroke. Results We included 435 patients. Presence of a bystander at symptom onset and knowledge of ≥2 core symptoms of stroke were associated with a primary emergency medical services contact. Higher stroke severity and patients or bystanders perceiving the situation as very serious were associated with a primary emergency medical services contact (ORpatients 2.10; 95% CI 1.12-3.95 and ORbystanders 22.60; 95% CI 4.98-102.67), <3 h from onset to arrival (ORpatients 3.01; 95% CI 1.46-6.21 and ORbystanders 4.44; 95% CI 1.37-14.39) and initiation of reperfusion therapy (ORpatients 3.08; 95% CI 1.23-7.75 and ORbystanders 4.70; 95% CI 1.14-19.5).Conclusion: Having a bystander, knowledge of ≥2 core symptoms and understanding that stroke is a serious event are associated with appropriate help-seeking behaviour, shorter prehospital delay and higher chance of reperfusion therapy in acute stroke patients.
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Affiliation(s)
- Ane Bull Iversen
- Department of Clinical Medicine - Neurology, Aarhus University, Aarhus N, Denmark.,Research Unit for General Practice, Aarhus C, Denmark.,Department of Public Health, Aarhus University, Aarhus C, Denmark
| | | | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Birgitte F Sandal
- Department of Neurology, Regional Hospital of West Jutland, Holstebro, Denmark
| | - Bo Christensen
- Research Unit for General Practice, Aarhus C, Denmark.,Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Grethe Andersen
- Department of Clinical Medicine - Neurology, Aarhus University, Aarhus N, Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice, Aarhus C, Denmark.,Department of Public Health, Aarhus University, Aarhus C, Denmark
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Gangadharan S, Lillicrap T, Miteff F, Garcia-Bermejo P, Wellings T, O'Brien B, Evans J, Alanati K, Levi C, Parsons MW, Bivard A, Garcia-Esperon C, Spratt NJ. Air vs. Road Decision for Endovascular Clot Retrieval in a Rural Telestroke Network. Front Neurol 2020; 11:628. [PMID: 32765396 PMCID: PMC7380106 DOI: 10.3389/fneur.2020.00628] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Telestroke aims to increase access to endovascular clot retrieval (ECR) for rural areas. There is limited information on transfer workflow for ECR in rural settings. We sought to describe the transfer metrics for ECR in a rural telestroke network with respect to decision making. Methods: A retrospective cohort study was employed on consecutive patients transferred to the comprehensive stroke center (CSC) for ECR in a rural hub-and-spoke telestroke network between April 2013 and October 2019, by road or air. Key time-based metrics were analyzed. Results: Sixty-two patients were included. Mean age was 66 years [standard deviation (SD), 14] and median National Institutes of Health Stroke Scale 13 [interquartile range (IQR), 8–18]. Median rural-hospital-door-to-CSC-door (D2D) was 308 min (IQR, 254–351), of which 68% was spent at rural hospitals [door-in-door-out (DIDO); 214 min; IQR, 171–247]. DIDO was longer for air transfers than road (P = 0.004), primarily because of a median 87 min greater decision-to-departure time (Decision-DO, P < 0.001). In multiple linear regression analysis, intubation but not thrombolysis was associated with significantly longer DIDO. The distance at which the extra speed of an aircraft made up for the delays involved in booking an aircraft was 299 km from the CSC. Conclusions: DIDO is longer for air retrievals compared with road. Decision-DO represents the most important component of DIDO, being longer for air transfers. Systems for rapid transportation of rural ECR candidates need optimization for best patient outcomes, with decision support seen as a potential tool to achieve this.
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Affiliation(s)
- Shyam Gangadharan
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Thomas Lillicrap
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Ferdinand Miteff
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Pablo Garcia-Bermejo
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Thomas Wellings
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Billy O'Brien
- Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
| | - James Evans
- Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
| | - Khaled Alanati
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Christopher Levi
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Mark W Parsons
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Andrew Bivard
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Carlos Garcia-Esperon
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Neil J Spratt
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
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Factors delaying intravenous thrombolytic therapy in acute ischaemic stroke: a systematic review of the literature. J Neurol 2020; 268:2723-2734. [PMID: 32206899 DOI: 10.1007/s00415-020-09803-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIMS This review examined factors that delay thrombolysis and what management strategies are currently employed to minimise this delay, with the aim of suggesting future directions to overcome bottlenecks in treatment delivery. METHODS A systematic review was performed according to PRISMA guidelines. The search strategy included a combination of synonyms and controlled vocabularies from Medical Subject Headings (MeSH) and EmTree covering brain ischemia, cerebrovascular accident, fibrinolytic therapy and Alteplase. The search was conducted using Medline (OVID), Embase (OVID), PubMed and Cochrane Library databases using truncations and Boolean operators. The literature search excluded review articles, trial protocols, opinion pieces and case reports. Inclusion criteria were: (1) The article directly related to thrombolysis in ischaemic stroke, and (2) The article examined at least one factor contributing to delay in thrombolytic therapy. RESULTS One hundred and fifty-two studies were included. Pre-hospital factors resulted in the greatest delay to thrombolysis administration. In-hospital factors relating to assessment, imaging and thrombolysis administration also contributed. Long onset-to-needle times were more common in those with atypical, or less severe, symptoms, the elderly, patients from lower socioeconomic backgrounds, and those living alone. Various strategies currently exist to reduce delays. Processes which have achieved the greatest improvements in time to thrombolysis are those which integrate out-of-hospital and in-hospital processes, such as the Helsinki model. CONCLUSION Further integrated processes are required to maximise patient benefit from thrombolysis. Expansion of community education to incorporate less common symptoms and provision of alert pagers for patients may provide further reduction in thrombolysis times.
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Oh GJ, Lee K, Kim K, Lee YH. Differences in the awareness of stroke symptoms and emergency response by occupation in the Korean general population. PLoS One 2019; 14:e0218608. [PMID: 31211797 PMCID: PMC6581263 DOI: 10.1371/journal.pone.0218608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/05/2019] [Indexed: 11/29/2022] Open
Abstract
We evaluated the difference in awareness of stroke warning signs (SWS) and emergency response among occupational groups in the community-dwelling population. From the 2016 Korea Community Health Survey, a total of 10,445 individuals without stroke were included in the analysis. Multiple logistic regression analysis was used to explore the association of occupation with awareness of SWS and correct emergency response. SWS included the following: sudden numbness or weakness, sudden difficulty speaking or understanding speech, sudden dizziness, sudden visual impairment, and sudden severe headache. Respondents’ occupation was classified into six groups: managers and professionals (MP); clerks; service and sales workers (SSW); agricultural, forestry, and fishery workers (AFFW); mechanical and manual laborers (MML); or housewives and unemployed people (HUP). Awareness of each SWS was the same with the highest for MP and lowest for AFFW. After adjusting for socio-demographic factors, compared to MP (reference), AFFW (odds ratio 0.49; 95% confidence interval 0.36–0.67), HUP (0.55; 0.40–0.75), MML (0.57; 0.42–0.79), and SSW (0.62; 0.45–0.86) had significantly lower ORs for knowing at least one of the SWS. Additionally, AFFW (0.79; 0.66–0.96) and MML (0.76; 0.63–0.91) had significantly lower ORs for knowing all five SWS compared to MP. However, there was no significant occupational difference in correct emergency response when a stroke occurred. To improve stroke literacy and to reduce the disparity of awareness of SWS in community settings, public health efforts with an emphasis on AFFW and MML are needed.
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Affiliation(s)
- Gyung-Jae Oh
- Department of Preventive Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Jeonbuk, Republic of Korea
- Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Jeonbuk, Republic of Korea
| | - Kyungsuk Lee
- National Institute of Agricultural Sciences, Rural Development Administration, Jeonju, Jeonbuk, Republic of Korea
| | - Kyungsu Kim
- National Institute of Agricultural Sciences, Rural Development Administration, Jeonju, Jeonbuk, Republic of Korea
| | - Young-Hoon Lee
- Department of Preventive Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Jeonbuk, Republic of Korea
- Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Jeonbuk, Republic of Korea
- * E-mail:
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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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Online Information about Stroke - A Soft Challenge for Critical Care Professionals. ACTA ACUST UNITED AC 2018; 4:147-148. [PMID: 30574568 PMCID: PMC6296278 DOI: 10.2478/jccm-2018-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/08/2018] [Indexed: 11/20/2022]
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Differences in and Determinants of Prehospital Delay Times among Stroke Patients-1994 Versus 2012. J Stroke Cerebrovasc Dis 2018; 27:2398-2404. [PMID: 29759941 DOI: 10.1016/j.jstrokecerebrovasdis.2018.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 04/23/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Prehospital delay is a challenge for stroke treatment and the delivery of time-critical treatments. Few studies have examined secular trends in prehospital delay, and results vary. This study investigates how prehospital delay among Norwegian stroke patients has changed over the last 2 decades. METHODS We compared time from symptom onset to admission in 2 cohorts of stroke patients admitted to Akershus University Hospital, Norway, in 1994 (n = 550) and 2012 (n = 522), and constructed predictive models for arrival within 3 hours for each cohort. RESULTS More patients arrived within 3 hours of symptom onset in 2012 compared to 1994 (proportion, 47.1% versus 19.3%, P < .001), also after adjusting for age, sex, and baseline differences; odds ratio (OR) was 5.14 (95% confidence interval [CI] 3.69-7.15). Stroke severity was the only predictor examined that was independently associated with early arrival during both periods. For patients with moderate strokes the overall OR was 2.06 (95% CI 1.41-3.00) and for severe strokes 4.52 (95% CI 2.97-6.87), compared to those with mild strokes. In the 1994 cohort additional predictors of early arrival were living with others and not being admitted from nursing home. CONCLUSIONS Prehospital delay in Norway has decreased considerably over the last 2 decades and since the availability of time-critical treatments. However, there is still an urgent need to reduce the number of delayed admissions as a large proportion of patients continue to arrive too late to benefit from these treatments. Patients with severer strokes were predicted to have earlier arrival.
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Sadeghi-Hokmabadi E, Farhoudi M, Taheraghdam A, Rikhtegar R, Ghafouri RR, Asadi R, Far EM, Ghaemian N, Mehrara M, Mirnour R. Prehospital notification can effectively reduce in-hospital delay for thrombolysis in acute stroke. FUTURE NEUROLOGY 2018. [DOI: 10.2217/fnl-2017-0031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To reduce in-hospital intervals by developing a prehospital notification (PHN) protocol which directly notifies a neurologist to prepare for possible treatment. Methods: A 24/7 connection was established between emergency medical services dispatch and the on-call neurologist. A database of all patients with in-hospital stroke code activation was developed, door-to-computed tomography (CT) time and door-to-needle time was recorded from January 2013 to December 2016. The statistical results were considered significant at p < 0.05. Result: PHN resulted in a significant reduction in door-to-CT time (median 14 vs 20; p < 0.001). Among patients who were treated with intravenous thrombolysis, door-to-needle time was significantly shorter in patients with PHN compared with non-PHN group (median 42 vs 70; p < 0.001). Conclusion: PHN effectively reduced door-to-CT and door-to-needle times.
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Affiliation(s)
- Elyar Sadeghi-Hokmabadi
- Neurosciences Research Center (NSRC), Neurology Department, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Farhoudi
- Neurosciences Research Center (NSRC), Neurology Department, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aliakbar Taheraghdam
- Neurosciences Research Center (NSRC), Neurology Department, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Rikhtegar
- Neurosciences Research Center (NSRC), Neurology Department, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rouzbeh Rajaei Ghafouri
- Emergency medicine research team, Emergency Department, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rogayyeh Asadi
- Neurosciences Research Center (NSRC), Neurology Department, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elham Mehdizadeh Far
- Neurosciences Research Center (NSRC), Neurology Department, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Ghaemian
- Neurosciences Research Center (NSRC), Neurology Department, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrdad Mehrara
- Neurosciences Research Center (NSRC), Neurology Department, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reshad Mirnour
- Neurosciences Research Center (NSRC), Neurology Department, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Response to Symptoms and Prehospital Delay in Stroke Patients. Is It Time to Reconsider Stroke Awareness Campaigns? J Stroke Cerebrovasc Dis 2017; 27:625-632. [PMID: 29108809 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/24/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite recent advances in acute stroke care, reperfusion therapies are given to only 1%-8% of patients. Previous studies have focused on prehospital or decision delay. We aim to give a more comprehensive view by addressing different time delays and decisions. METHODS A total of 382 patients with either acute stroke or transient ischemic attack were prospectively included. Sociodemographic and clinical parameters and data on decision delay, prehospital delay, and first medical contact were recorded. Multivariate logistic regression analyses were conducted to identify factors related to decision delay of 15 minutes or shorter, calling the Extrahospital Emergency Services, and prehospital delay of 60 minutes or shorter and 180 minutes or shorter. RESULTS Prehospital delay was 60 minutes or shorter in 11.3% of our patients and 180 minutes or shorter in 48.7%. Major vascular risk factors were present in 89.8% of patients. Severity was associated with decision delay of 15 minutes or shorter (odds ratio [OR] 1.08; confidence interval [CI] 1.04-1.13), calling the Extrahospital Emergency Services (OR 1.17; CI 1.12-1.23), and prehospital delay of 180 minutes or shorter (OR 1.08; CI 1.01-1.15). Adult children as witnesses favored a decision delay of 15 minutes or shorter (OR 3.44; CI 95% 1.88-6.27; P < .001) and calling the Extrahospital Emergency Services (OR 2.24; IC 95% 1.20-4.22; P = .012). Calling the Extrahospital Emergency Services favored prehospital delay of 60 minutes or shorter (OR 5.69; CI 95% 2.41-13.45; P < .001) and prehospital delay of 180 minutes or shorter (OR 3.86; CI 95% 1.47-10.11; P = .006). CONCLUSIONS Severity and the bystander play a critical role in the response to stroke. Calling the Extrahospital Emergency Services promotes shorter delays. Future interventions should encourage immediately calling the Extrahospital Emergency Services, but the target should be redirected to those with known risk factors and their caregivers.
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Muller FF, de Beer F, Visser MC. Variation in Organization of Transient Ischemic Attack Care in The Netherlands. A Nationwide Survey Study. J Stroke Cerebrovasc Dis 2017; 26:1899-1903. [PMID: 28736131 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.033] [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: 10/14/2016] [Revised: 06/12/2017] [Accepted: 06/23/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Previous research has shown the importance of urgent initiation of antiplatelet therapy after transient ischemic attack (TIA) to reduce the risk of stroke. Many hospitals in the Netherlands have therefore implemented rapid pathways for assessment of patients with TIA. Dutch stroke guidelines lack clear directives for organization of TIA assessment and thus allow for variation. The aim of this study was to investigate variation in organization of TIA assessment in Dutch hospitals. METHODS One neurologist per hospital (of 88 Dutch hospitals) with special interest in stroke was invited to participate in a web-based survey addressing the organization, content, and timing of TIA assessment. RESULTS Seventy (80%) neurologists completed the survey, all of whom reported performing TIA assessment in their hospital. There was considerable variation in the method of application and the location of assessment. In 10% of the hospitals, patients with TIA are always admitted to the ward. The content of diagnostics is fairly similar, but hospitals vary in the extent of cardiological workup. Almost all hospitals aim for a swift start of assessment as directed by guidelines, but access time differs. Eighty-six percent of respondents reported that antiplatelet therapy is usually initiated before assessment, based on history. CONCLUSIONS This study showed variation in organization of TIA assessment in Dutch hospitals, especially regarding location within the hospital, time to assessment after announcement, and cardiological workup. Further research is needed to investigate implications of this variation for quality of care.
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Affiliation(s)
| | - Frank de Beer
- Department of Neurology, Spaarne Gasthuis, Haarlem 2035 RC, The Netherlands
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Wang Y, Hafeez A, Meng F, Zhang R, Wang X, Chen X, Kong Q, Du H, Ma X. The correlation of D-dimer levels with patient outcomes in acute ischemic cerebrovascular disease complicating coronary heart disease. Neurol Res 2017; 38:524-32. [PMID: 27320247 DOI: 10.1080/01616412.2016.1187829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the correlation between nerve function defect, their degree of recovery, and D-dimer levels in patients with acute ischemic cerebrovascular disease (AICVD) complicating coronary heart disease (CHD) in winter. METHODS From 1 October, 2014 to 31 December, 2014, we enrolled patients in a consecutive manner with AICVD who were hospitalized in the Department of Neurology, Beijing Luhe hospital, Capital Medical University. The patients were selected that had an occurrence of AICVD within the last 14 days. A total of 151 cases were divided into CHD group (n = 77) or non-CHD group (n = 74) based on a diagnosis of CHD. The risk factors, hematological indices associated with the diseases, and the nerve function defect and recovery degrees were compared between the two groups. Moreover, according to the result of the preliminary analysis of the CHD and non-CHD groups, patients were further divided into two subgroups based on whether their D-dimer levels were higher than 0.5 mg/l or not. Finally, the nerve function defect and recovery degrees in each subgroups were compared in pairs. RESULTS Among the patients consecutively enrolled, the percentage of the patients with CHD was 50.99% (77/151) and non-CHD patients was 49.01%. On admission, there was no significant difference in NIHSS scores between the CHD and non-CHD groups. However, there was a significant difference between the CHD and non-CHD groups when comparing the NIHSS scores on 14th day and the mRs scores on 90 (±7)th day after the initial onset (p = 0.006, 0.005). The D-dimer levels of AICVD complicating CHD patients were higher than those not complicating CHD patients (p = 0.006). Those AICVD patients that complicating CHD with also elevated D-dimer levels had most severe neurologic function deficits on 14th day and worst neural function recoveries on 90 (±7)th day after onset (p = 0.001, <0.001). CONCLUSIONS AICVD patients complicating CHD is very common in clinical practice. The AICVD patients that complicating CHD showed worse outcomes within 90 days after initial onset of stroke. The D-dimer levels of patients with AICVD complicating CHD were higher. Patients in the CHD group, whose D-dimer levels were higher than the normal standard, had worst outcomes. Paying close attention to the stage of the coronary artery disease and indicators of the coagulation-fibrinolysis is beneficial in the optimization of the clinical treatment for AICVD patients. Maybe the results of this study could provide some reference for specific groups of stroke patients to accept anticoagulant therapy.
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Affiliation(s)
- Yanling Wang
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China.,c Department of Neurology , Xuanwu Hospital, Capital Medical University , Beijing , China
| | - Adam Hafeez
- b Department of Neurological Surgery , Wayne State University School of Medicine , Detroit , MI , USA
| | - Fanhua Meng
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Ruihua Zhang
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Xuemei Wang
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Xiaomeng Chen
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Qi Kong
- c Department of Neurology , Xuanwu Hospital, Capital Medical University , Beijing , China
| | - Huishan Du
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Xin Ma
- c Department of Neurology , Xuanwu Hospital, Capital Medical University , Beijing , China
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Mackay MT, Stojanovski B, Mosley I, Churilov L, Donnan GA, Monagle P. Parental Care-Seeking Behavior and Prehospital Timelines of Care in Childhood Arterial Ischemic Stroke. Stroke 2016; 47:2638-40. [PMID: 27608817 DOI: 10.1161/strokeaha.116.014728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 08/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Taking appropriate action in the prehospital setting is important for rapid stroke diagnosis in adults. Data are lacking for children. We aimed to describe parental care-seeking behavior and prehospital timelines of care in childhood arterial ischemic stroke. METHODS A structured questionnaire was developed, using value-focused event-driven conceptual modeling techniques, to interview parents of children presenting to the emergency department with arterial ischemic stroke from 2008 to 2014. RESULTS Twenty-five parents (median age 41 years, interquartile range 36-45) were interviewed. Twenty-four children were awake, and 1 child was asleep at stroke onset; 23 had sudden onset symptoms. Location at stroke onset included home (72%), school (8%), or other setting (20%). Carergivers present included parent (76%), another child (8%), teacher (4%), or alone (8%). Eighty-four percent of parents thought symptoms were serious, and 83% thought immediate action was required, but only 48% considered the possibility of stroke. Initial actions included calling an ambulance (36%), wait and see (24%), calling a general practitioner (16%) or family member (8%), and driving to the emergency department or family physician (both 8%). Median time from onset to emergency department arrival was 76 minutes (interquartile range 53-187), being shorter for ambulance-transported patients. CONCLUSIONS Stroke recognition and care-seeking behavior are suboptimal, with less than half the parents considering stroke or calling an ambulance. Initiatives are required to educate parents about appropriate actions to facilitate time-critical interventions.
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Affiliation(s)
- Mark T Mackay
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia.
| | - Belinda Stojanovski
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia
| | - Ian Mosley
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia
| | - Leonid Churilov
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia
| | - Geoffrey A Donnan
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia
| | - Paul Monagle
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia
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Naess H, Kurtz M, Thomassen L, Waje-Andreassen U. Serial NIHSS scores in patients with acute cerebral infarction. Acta Neurol Scand 2016; 133:415-20. [PMID: 27045895 DOI: 10.1111/ane.12477] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 11/30/2022]
Abstract
AIM To study time course of neurological deficits in patients with acute cerebral infarction admitted shortly after stroke onset. METHODS Serial NIHSS scores were obtained whenever feasible in patients admitted because of cerebral infarction within 3 h of symptom onset. Patients receiving and not receiving thrombolysis were compared. Short-term outcome was defined as NIHSS score and modified Rankin score 7 days after stroke onset. The hyperacute phase was defined as the time between stroke onset and the 6- to 9-h interval after stroke onset, acute phase as the time between the 6- to 9-h interval and the 21 to 27-h interval, and the subacute phase as the time between the 21- to 27-h interval and 7 days after stroke onset. RESULTS Serial NIHSS scores were obtained in 552 patients within three hours of stroke onset. There was a significant improvement (P < 0.001) comprising 62% of the total improvement in the hyperacute phase. There was no significant improvement in the acute phase and a small significant improvement in the subacute phase (P < 0.01). CONCLUSION Our study demonstrates a hyperacute phase with rapid improvement probably due to early recanalization, an acute phase with no significant improvement and slow improvement in the subacute phase. Different pathophysiological mechanisms are likely involved in the different phases.
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Affiliation(s)
- H. Naess
- Department of neurology; Haukeland University Hospital; Bergen Norway
- Centre for age-related medicine; Stavanger University Hospital; Stavanger Norway
- Institute of clinical medicine; University of Bergen; Bergen Norway
| | - M. Kurtz
- Department of Neurology; Stavanger University Hospital; Stavanger Norway
| | - L. Thomassen
- Department of neurology; Haukeland University Hospital; Bergen Norway
- Institute of clinical medicine; University of Bergen; Bergen Norway
| | - U. Waje-Andreassen
- Department of neurology; Haukeland University Hospital; Bergen Norway
- Institute of clinical medicine; University of Bergen; Bergen Norway
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Mohamad NF, Hastrup S, Rasmussen M, Andersen MS, Johnsen SP, Andersen G, Simonsen CZ. Bypassing primary stroke centre reduces delay and improves outcomes for patients with large vessel occlusion. Eur Stroke J 2016; 1:85-92. [PMID: 31008269 DOI: 10.1177/2396987316647857] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/11/2016] [Indexed: 11/17/2022] Open
Abstract
Objective In large-vessel occlusion, endovascular therapy is superior to medical management alone in achieving recanalisation. Reducing time delays to revascularisation in patients with large-vessel occlusion is important to improving outcome. Patients and methods A campaign was implemented in the Central Denmark Region targeting the identification of patients with large-vessel occlusion for direct transport to a comprehensive stroke centre. Time delays and outcomes before and after the intervention were assessed. Results A total of 476 patients (153 pre-intervention and 323 post-intervention) were included. They were treated with either intravenous tissue plasminogen activator or endovascular treatment (alone or in combination with intravenous tissue plasminogen activator). Endovascular therapy patients' median system delay was reduced from 234 to 185 min (adjusted relative risk delay 0.79 (95% confidence interval: 0.67-0.93)). The in-hospital delay was the main driver with an adjusted relative risk delay of 0.76 (confidence interval: 0.62-0.94), while pre-hospital delay was almost significantly reduced with an adjusted relative delay of 0.86 (confidence interval: 0.71-1.04). This was achieved without increasing the intravenous tissue plasminogen activator-treated patients' delay. Significantly more patients treated with endovascular therapy in the post-interventional period achieved functional independence (62% versus 43%), corresponding to an adjusted odds ratio of 3.08 (95% confidence interval: 1.08-8.78). Conclusion Direct transfer of patients with suspected large-vessel occlusion to a comprehensive stroke centre leads to shorter treatment times for endovascular therapy patients and is, in turn, associated with an increase in functional independence. We recorded no adverse effects on intravenous tissue plasminogen activator treatment times or outcome.
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Affiliation(s)
- Niwar Faisal Mohamad
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sidsel Hastrup
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Rasmussen
- Department of Neuroanaestesia, Aarhus University Hospital, Aarhus, Denmark.,Helicopter Emergency Medical Service, Danish Air Ambulance, Denmark
| | - Mikkel Strømgaard Andersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Pre-hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Grethe Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Patient perspectives of barriers and facilitators of treatment-seeking behaviors for stroke care. J Neurosci Nurs 2016; 47:154-9. [PMID: 25859748 DOI: 10.1097/jnn.0000000000000134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Delays in seeking treatment for stroke care are associated with greater disability and reductions in stroke outcomes. The objective of this study was to qualitatively examine facilitators and barriers to urgently seeking stroke-related care. METHODS A qualitative analytic approach was used to explore facilitators and barriers to seeking stroke care in an urgent manner. Sixty-four stroke survivors offered information related to facilitators and barriers to stroke care via a structured survey as part of a larger mixed-methods study designed to measure stroke outcomes. RESULTS Three themes emerged related to facilitators and barriers: (a) recognition of symptoms, (b) social support, and (c) knowledge and ability to call emergency medical services as a first response. Facilitators to urgent care-seeking behaviors included classic stroke symptoms, severe symptoms, sudden symptom onset, and high perceived level of emergency. Social support and knowledge/ability to call emergency medical services also emerged as facilitators of urgent care. Barriers to urgent care-seeking behaviors included atypical symptoms, mild symptoms, gradual symptom onset, and low perceived level of emergency. CONCLUSIONS Individuals who experience strokes face a number of facilitators and barriers to seeking urgent care for their condition. Facilitators and barriers are associated with stroke symptoms and their personal environments. Additional study of barriers to stroke care is needed to adequately design interventions to reduce delays in seeking treatment.
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Badachi S, Mathew T, Prabhu A, Nadig R, Sarma GRK. Hurdles in stroke thrombolysis: Experience from 100 consecutive ischemic stroke patients. Ann Indian Acad Neurol 2015; 18:415-8. [PMID: 26713013 PMCID: PMC4683880 DOI: 10.4103/0972-2327.165460] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Acute management of ischemic stroke involves thrombolysis within 4.5 h. For a successful outcome, early recognition of stroke, transportation to the hospital emergency department immediately after stroke, timely imaging, proper diagnosis, and thrombolysis within 4.5 h is of paramount importance. Aim: To analyze the obstacles for thrombolysis in acute stroke patients. Materials and Methods: The study was conducted in a tertiary care center in South India. A total of hundred consecutive patients of acute ischemic stroke who were not thrombolysed, but otherwise fulfilled the criteria for thrombolysis were evaluated prospectively for various factors that prevented thrombolysis. The constraints to thrombolysis were categorized into: i) Failure of patient to recognize stroke symptoms, ii) patient's awareness of thrombolysis as a treatment modality for stroke, iii) failure of patient's relative to recognize stroke, iv) failure of primary care physician to recognize stroke, v) transport delays, vi) lack of neuroimaging and thrombolysis facility, and vii) nonaffordability. Results: The biggest hurdle for early hospital presentation is failure of patients to recognize stroke (73%), followed by lack of neuroimaging facility (58%), nonaffordability (56%), failure of patient's relative to recognize stroke (38%), failure of the primary care physician to recognize stroke (21%), and transport problems (13%). Awareness of thrombolysis as a treatment modality for stroke was seen only in 2%. Conclusion: Considering the urgency of therapeutic measures in acute stroke, there is necessity and room for improvement to overcome various hurdles that prevent thrombolysis.
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Affiliation(s)
- Sagar Badachi
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Thomas Mathew
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Arvind Prabhu
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Raghunandan Nadig
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Gosala R K Sarma
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
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