Factors associated with onset to hospital delay among stroke patient in emergency department

Abstract

Ischemic stroke is the most common neuro-emergency in the world. The only treatment approved for an acute stroke is thrombolysis, which has a narrow window. Thrombolysis to treat acute ischemic stroke is under-utilised. There are many factors associated with delays in treatment. In Indonesia, thrombolysis is not commonly used for acute stroke treatment. The study aimed to know what time is needed from the onset of the stroke condition to the Emergency Department in a stroke patient and the factors associated with the hospital delays. All stroke patients admitted to Dr. Soetomo General Hospital and Universitas Airlangga Hospital between October 2016-March 2017, who agree to participate in the research and were aged >18 y.o. are included. We reviewed all of the subjects for the demographic characteristics, distance to hospital, stroke risk factors and clinical data. All of the subjects will be asked for the time of stroke onset and the time when the patient arrived at the emergency department. We will also measure the stroke using a specialised scale. Results There were 107 subjects included in this research. The data was inadequate in 4 subjects. The mean age was 55.97±11.9 years, and there were more women (54.2%) than men. The distance from the patient's home to the hospital was mostly <15 km (65.1%). 63.6% of the subjects were referred from other hospital or clinic. Most of the patients had hypertension (71.4%) and diabetes (31.7%). Onset from the ictus of the stroke to the Emergency Department was 712.3±1324.6 minutes. A factor associated with the delay was the medical services accessed before the patient was referred to the hospital (0.215; p=0.026) and their pre-admission score (0.242; p=0.012). Conclusion Time from onset to the Emergency Department was longer than the treatment time window for thrombolysis. The factors associated with the onset of hospital delays was primary medical services and the pre-mRS score.