Barriers for acute ischemic stroke treatment using recombinant tissue plasminogen activator in Mansoura Emergency Hospital: prehospital and inhospital delay factors

Abstract

Introduction Effective treatment must start as early as possible as brain cells die rapidly after stroke. To increase the number of patients who are eligible to receive tissue plasminogen activator, measures are needed to reduce the prehospital and inhospital delay time. The study aimed to evaluate the possibility of thrombolytic therapy in acute ischemic stroke patients in Mansoura Emergency Hospital (MEH) by studying the effect of prehospital and inhospital delay factors. Patients and methods A standardized, structured questionnaire was completed for every stroke suspect; in it we documented the exact time of stroke onset, the way of referral and transport to hospital, and their demographic data. The exact time of patient arrival, time to neurology consultation, and detailed time delay inside MEH was marked on the forms of the hospital as well. Results In total, 435 patients had arrived MEH in less than 24 h, their mean age being 61.7 years. The median prehospital time was 2.7 h. Patients with younger age, locals, those who reached by private vehicle, or reached directly without any medical reference were significantly associated with early hospital admission. Sex, time of arrival, or severity of stroke had no influence on reaching hospital early. The median times to computed tomography request and acquisition were 20 and 35 min versus 25 and 45 min, respectively, National Institute of Neurological Disorders and Stroke recommendations. Conclusion Hyperacute treatment of ischemic stroke is possible in MEH. Methods to improve the emergency medical services and reduction of the patient circulation system in MEH will give more chance for these therapies by reducing prehospital and inhospital delay times.