European Stroke Organization guidelines for the lmnagement of intracraniai aneurysrm and subarachnoid haemontmge

Abstract

Objective To investigate the characteristics of prehospital delay and influencing factors in patients with acute ischemic stroke in Dongguan,Guangdong.Methods Consecutive inpatients with acute ischemic stroke were registered prospectively from May 1,2012 to September 30,2012.Questionnaires and interviews were used to investigate the pre-hospital delay （from the time of stroke onset to decision to seek medical help） and the time needed for transportation （from medical decision to arriving at the hospital）.The variables such as the scene of stroke,cognitive behavior,and sociodemography were documented.Univariate and multivariate analyses were used to study the influencing factors for prehospital delay.Results A total of 151 patients with acute ischemic stroke were enrolled,and 53 of them （35.1％） made decision to seek medical help within 2 hours after symptom onset （early decision group）; 98 of them made decision to seek medical help after 2 hours of symptom onset （decision delay group）.The National Institutes of Health Stroke Scale （NIHSS） scores （median [M],interquartile range [IQR]：5.0 [3.0-12.0] vs.4.0 [2.0-6.0] ; Z =-2.342,P =0.019）,and the proportions of presence of bystander at the time of symptom onset （94.3％ vs.37.8％;x2 =42.812,P＜0.001）,awaring of the onset of stroke （62.3％ vs.39.8％;x2 =6.961,P =0.008）,knowing thrombolytic treatment （22.6％ vs.3.1％ ; x2 =12.632,P ＜ 0.001） in the early decision group were significantly higher than those in the decision delay group; there were significant difference in the proportions of transport modes between the early decision group and the decision delay group （x2 =22.696,P＜ 0.001）.Barthel index on admission （M,IQR） （65.0 [40.0-80.0] vs.80.0 [60.0-90.0]; Z=-3.210,P=0.001） in the early decision group was significantly lower than that in the decision delay group.The time of recognizing and making decision was significantly shorter than that in the decision delay group （1.04 ±0.62 h vs.13.8 ± 11.9 h; P=-7.748,P＜0.001）,but there was no significant difference in transport time （2.07 ± 4.24 h vs.2.08 ± 4.58 h; t =-0.160,P =0.987）.Multivariate logistic regression analysis showed that presence of bystander at the time of symptom onset was an independent influencing factor for early decision to seek medical help （odds ratio [OR] 0.046,95％confidence interval [CI]0.013-0.163; P ＜ 0.001）,while the higher baseline Barthel index （OR 1.022,95％ CI 1.004-1.040; P =0.016） and the onset at night （OR 1.258,95％ CI 1.043-1.517; P =0.034）were the independent influencing factors for decision delay.Conclusions The decision delay to seek medical help is a main reason for prehospital delay in acute ischemic stroke.Presence of bystander at the time of symptom onset is an important factor for decreasing decision delay.The popularity and strengthen the health education of stroke among the population of young and middle-aged bystanders may enable more patients with acute ischemic stroke benefit from thrombolysis therapy. Key words: Stroke; Brain Ischemia; Hospitalization; Emergency Medical Services; Time Factors