Pre and in-hospital delay in the use of thrombolytic therapy for acute ischemic stroke patients in Egypt

Abstract

Stroke patients in Egypt don’t receive enough i.v thrombolytic therapy because they presented outside the therapeutic time window. It's important to understand the factors behind pre- and in-hospital delays of those patients. This prospective observational study included 296 patient presented with acute ischemic stroke and did not receive thrombolytic therapy from January, 2018, to June, 2018. from 3 large tertiary university hospitals (Assiut, Cairo and Tanta). A detailed history including the demographic data, which alarm patients notified, time of emergency medical service arrival, onset-to-door time , door-to-examination time, door-to-imaging time , door-to-laboratory time, the time interval between obtaining the test result and the needle time. NIHSS and mRS were carried out for each patient at admission and discharge. 156 patients were male and 140 were female, 200 patients came from rural area, 96 from urban area. The mean age was 62.5. A prehospital delay was reported for all patients and it had multiple reasons like Stroke misdiagnosis, delay in alarming emergency services, time wasting in referral from hospital to another. Intra-hospital time wasting was calculated for patients who came only in therapeutic time window (117 patient). It has multiple factors in which time delay till obtaining laboratory results and making decision contributed the most. Pre and In-hospital delays reduced the number of patients eligible for IV thrombolysis in Egypt. Efforts should focus on increasing awareness about stroke and its symptoms between general population and Health care professionals, and improvement of the pathway organization inside the Hospitals.