‘Prehospital’ delay in acute stroke reperfusion therapy in Delhi: Time for introspection

Abstract

The reasons for prehospital delay in acute stroke reperfusion care are many including delay in seeking medical care or delay after the Initial Medical Contact (IMC). We tried to find out the timing of IMC of patients coming to AIIMS Delhi Emergency Stroke Services. The data was collected prospectively (July10, 2018-Mar10, 2019) from the feasibility screening log of an on-going RCT (PROLEVIS).All Stroke patients admitted in Unit 2 were included. Time of onset of stroke, neuroimaging, arrival time at IMC/AIIMS were collected prospectively. We screened 127patients and 3 were excluded for insufficient data. Forty nine patients arrived AIIMS directly and 75 patients had IMC elsewhere. Of these 75 patients (Ischemic stroke-35, ICH-32, CVT-8), 61 (IS-27) reached within 4.5 hrs, 65 (IS-30 )within 6 hrs, 72 within 24 hrs. Of the 30 ischemic stroke patients (IMC < 6 hrs),29 (39%) had neuroimaging before referral, but only 2 patients were thrombolysed (AIIMS). Among the IS with IMC outside AIIMS, 13 patients were wake up stroke (11 patients are within 4.5 hrs). Out of 49 patients (IS-40, ICH-9) who directly reached AIIMS, 34 were within 4.5 hrs (IS-26), within 6 hrs-37 (IS-28), within 24 hrs -47 (IS-38). Eight patients within 4.5 hrs were wake up stroke. 35% (14/40, IVT-10, MT-4) of Ischemic stroke patients reaching AIIMS directly underwent acute stroke reperfusion therapy. Nearly half of (46%) Ischemic stroke patients reaching AIIMS have IMC outside and 77.1% of these reach IMC within 4.5 hrs.