Abstract WP307: Pre-Hospital Delay for Acute Ischemic Stroke in the New Era: K-Plus Registry

Abstract

Background and Purpose: Changes in hyperacute stroke treatment emphasize the needs for earlier treatment than ever. Considering there is a limitation to shorten in-hospital delay in acute ischemic stroke, decreasing pre-hospital delay is crucial to achieve earlier recanalization and better clinical outcome. We investigated the factors causing prehospital delay and its relationship with clinical outcome, using the data of a regional multicenter stroke registry: K-PLUS. Method: Patients with acute ischemic stroke within 24 hours of the last time known well in K-PLUS, registered from 2013 to 2017, were included. We divided them into two groups according to the period from the last time known well to admission: early admission (within 4 hours) and delayed admission (over 4 hours). Age, sex, prehospital modified Rankin Scale (mRS) score, use of emergency system, location of onset, living places, risk factors, dementia, and previous medical history were compared between the two groups. The relationship between the prehospital delay and prognosis was also examined. Results: Of 5,102 patients (median 78 years old; women, 42%), 2,752 (54%) were admitted within 4 hours. As a result of multivariate analysis, mRS 0-2 before onset (odds ratio, 1.2; 95% confidence interval, 1.0-1.5), atrial fibrillation (1.7; 1.5-1.9), immediate symptom detection (2.8; 2.4-3.2), onset outside home (2.5; 2.1-3.0), and emergency system use (2.9; 2.5-3.4) were positively related to, and diabetes (0.7; 0.6-0.8), current smoking (0.8; 0.7-0.9), dementia (0.8; 0.6-1.0), and symptom detection at 6:00-24:00 (0.5; 0.4-0.5) were negatively related to early admission. Early admission was related to directly discharging home independent of age, living at home before admission, NIHSS score on admission, and thrombolytic therapy (1.6; 1.4-1.9). Conclusions: We elucidated clinical characteristics related to early admission within 4 hours in acute ischemic stroke patients. Moreover, earlier admission was related to discharging home independent of other factors. Educational activities to general population for early symptom detection and emergency call are necessary for early admission.