Abstract
BackgroundDelayed arrival at hospital is one of the major obstacles in enhancing the rate of thrombolysis therapy in patients with acute ischemic stroke. Our study aimed to investigate factors associated with prehospital delay after acute ischemic stroke in Korea.MethodsA prospective, multicenter study was conducted at 14 tertiary hospitals in Korea from March 2009 to July 2009. We interviewed 500 consecutive patients with acute ischemic stroke who arrived within 48 hours. Univariate and multivariate analyses were performed to evaluate factors influencing prehospital delay.ResultsAmong the 500 patients (median 67 years, 62% men), the median time interval from symptom onset to arrival was 474 minutes (interquartile range, 170-1313). Early arrival within 3 hours of symptom onset was significantly associated with the following factors: high National Institutes of Health Stroke Scale (NIHSS) score, previous stroke, atrial fibrillation, use of ambulance, knowledge about thrombolysis and awareness of the patient/bystander that the initial symptom was a stroke. Multivariable logistic regression analysis indicated that awareness of the patient/bystander that the initial symptom was a stroke (OR 4.438, 95% CI 2.669-7.381), knowledge about thrombolysis (OR 2.002, 95% CI 1.104-3.633) and use of ambulance (OR 1.961, 95% CI 1.176-3.270) were significantly associated with early arrival.ConclusionsIn Korea, stroke awareness not only on the part of patients, but also of bystanders, had a great impact on early arrival at hospital. To increase the rate of thrombolysis therapy and the incidence of favorable outcomes, extensive general public education including how to recognize stroke symptoms would be important.
Highlights
Delayed arrival at hospital is one of the major obstacles in enhancing the rate of thrombolysis therapy in patients with acute ischemic stroke
Despite current evidences supporting the time extension of intravenous recombinant tissue plasminogen activator therapy in acute ischemic stroke patients, it is well known that early administration of thrombolytics is beneficial for patient outcome [1]
There have been numerous studies of the factors associated with prehospital delay and some factors such as contacting the primary physician, or not using Emergency Medical Services (EMS), were in almost all cases found to be associated with delayed arrival time [4,5]
Summary
Delayed arrival at hospital is one of the major obstacles in enhancing the rate of thrombolysis therapy in patients with acute ischemic stroke. Our study aimed to investigate factors associated with prehospital delay after acute ischemic stroke in Korea. Since intravenous rt-PA is the only approved treatment for acute ischemic stroke, shortening the time between symptom onset and hospital arrival is important. Many interventions to reduce prehospital delay have been conducted, 3-8.5% of all stroke patients receive thrombolytic therapy in the US [2] and only 2.1% in Korea [3]. Perceptual, social and behavioral factors, rather than knowledge, were suggested to be important for decreasing arrival delay [6], and the role of the bystander in delivery of acute stroke was highlighted. The results of large studies in other countries may not be applicable in Korea, and it is likely that rapid reactions on the part of bystander after the onset of stroke symptoms may be extremely important
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