Abstract
(1) Background: The benefit of acute ischemic stroke (AIS) treatment declines with any time delay until treatment. Hence, factors influencing the time from symptom onset to admission (TTA) are of utmost importance. This study aimed to assess temporal trends and risk factors for delays in TTA. (2) Methods: We included 1244 consecutive patients from 2015 to 2018 with suspected stroke presenting within 24 h after symptom onset registered in our prospective, pre-specified hospital database. Temporal trends were assessed by comparing with a cohort of a previous study in 2006. Factors associated with TTA were assessed by univariable and multivariable regression analysis. (3) Results: In 1244 patients (median [IQR] age 73 [60–82] years; 44% women), the median TTA was 96 min (IQR 66–164). The prehospital time delay reduced by 27% in the last 12 years and the rate of patients referred by Emergency medical services (EMS) increased from 17% to 51% and the TTA for admissions by General Practitioner (GP) declined from 244 to 207 min. Factors associated with a delay in TTA were stroke severity (beta−1.9; 95% CI–3.6 to −0.2 min per point NIHSS score), referral by General Practitioner (GP, beta +140 min, 95% CI 100–179), self-admission (+92 min, 95% CI 57–128) as compared to admission by emergency medical services (EMS) and symptom onset during nighttime (+57 min, 95% CI 30–85). Conclusions: Although TTA improved markedly since 2006, our data indicates that continuous efforts are mandatory to raise public awareness on the importance of fast hospital referral in patients with suspected stroke by directly informing EMS, avoiding contact of a GP, and maintaining high effort for fast transportation also in patients with milder symptoms.
Highlights
The benefit of acute ischemic stroke (AIS) management is strongly time dependent
The prehospital time delay reduced by 27% in the last 12 years and the rate of patients referred by Emergency medical services (EMS) increased from 17% to 51% and the time from symptom onset to admission (TTA) for admissions by General Practitioner (GP) declined from 244 to 207 min
Factors associated with a delay in TTA were stroke severity, referral by General Practitioner (GP, beta +140 min, 95% CI 100–179), self-admission (+92 min, 95% CI 57–128) as compared to admission by emergency medical services (EMS) and symptom onset during nighttime (+57 min, 95% CI 30–85)
Summary
The benefit of acute ischemic stroke (AIS) management is strongly time dependent. The time window for recanalization therapies has extended over the last decades. Thrombolysis has shown to improve outcome in selected patients up to 9 h after symptom onset [1], while endovascular thrombectomy lowered disability in selected patients with a large vessel occlusion up to 16–24 h after onset [2,3]. For endovascular treatment and thrombolysis [4,5,6] as well as. Jc. oCnlins.eMrveda.t2iv02e0m, 9,exdFicOaRl PmEaEnRaRgEeVmIEeWnt [7] the time from symptom onset to initiation of therapy rema2inofs 8a decisive factor for functional outcome [6]. While efforts to reduce the door-to-treatment time have led dtooosrig-tnoi-ftirceaanttmimenptrotivmeemhenavtse[8le],dthtoe dsiegvneilfoicpamntenimt opfropvreehmoesnptistal[8d],eltahyes dinevAeIlSopremmeanitnosfcopnretrhoovsepristiaall. While efforts to reduce the door-to-treatment time have led dtooosrig-tnoi-ftirceaanttmimenptrotivmeemhenavtse[8le],dthtoe dsiegvneilfoicpamntenimt opfropvreehmoesnptistal[8d],eltahyes dinevAeIlSopremmeanitnosfcopnretrhoovsepristiaall. dVealraiyous singlAobISalrreemviaeiwnss creopnotrrotevderdsiivael.rgVeanrtioreussugltlsowbaitlhrerevgieawrdstroetphoerpterdehdoisvpeirtgaletnimt reesimulptsrowvietmh ernegt aarndd ttohethfeacptorerhs olesapditinalgttimo deeilmaypr[9o–v1e1m].eFnotraenxdamthpelfea,cthtoerismlepaadcitnogf taopdreelvaiyou[9s–c1e1re].bFroovraesxcaumlaprleev, ethnet (ipmCpVaEct), oi.fea., pprreevviioouussscterorekberoorvtarascnusileanrteivscehnetm(picCaVttEa)c,ki.(eT.,IApr)einvitohuespsattrioeknet moredtriacnalsiheinsttoirsychoenmthice atitmtaeckto(hToIAsp)iitnal tahdempiastsiieonnt m(TeTdAic) arlemhisationrsyuonncetrhteaitnim. eAtdodhitoiospniatlalyl ,atdhmeriessiisoan l(aTcTkAo)frdemataaionns uthneceirmtapianc.tAodfdoiptitoimnaizlleyd, tphreerheoisspaitlaalcwkoorfkdflaotwa so.n the impact of optimized prehospital workflows.
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