Prehospital Delay Time Research Articles

Risk Factors of Perforation of Appendix and Unfavorable Outcome in Delayed Presentation of Acute Appendicitis: A Cross-Sectional Analysis

Background: Perforated or gangrenous appendicitis in patient with a lately presented acute appendicitis remains a challenge for practicing surgeons and continues to be associated with more deadly complications. Results might improve with earlier consideration of the diagnosis followed by prompt surgical intervention. Objective: To identify the risk factors of appendiceal perforation, gangrene and other sequelae in patients with delayed presentation of acute appendicitis and its effects on the prognosis. Patients and Methods: This cross-sectional study was carried out from January, 2015 to July, 2017 (2½ years) in Rajshahi medical college hospital and also it’s neighboring several private hospitals. Those patients of both genders between 12 years to 65 years old, admitted during that period with signs and symptoms of acute appendicitis for more than 48 hours but otherwise healthy (i.e. not having any other comorbidities) were subjected to the present study. The parameters of our study were incidence of appendiceal perforation or gangrene, peri-appendiceal abscess formation, generalized peritonitis, length of hospital stay and post-operative complications. Results: During the study period, a total of 73 patients underwent appendicectomies and 23 patients were excluded, leaving 50 who met the inclusion criteria, 23 males (46%) and 27 females (54%). Of all the risk factors studied, the patient’s pre-hospital time delay was the most important risk factor for perforation (43 patients i.e. 86%) and there were little number of patients with the in-hospital delay (7 patients i.e. 14%). The reasons behind this pre-hospital as well as in-hospital delay were multifactorial. Overall appendiceal perforation occurred in 22 (44%) patients, patients presented with gangrenous appendicitis were 14 (28%), periappendiceal abscess formation was found in 9 (18%) patients, and patients presented with generalized peritonitis were 5 (10%). The duration of hospital stay ranged from several days to several weeks. Post-operative complications occurred in 40 (80%) cases. Post-operative complications were monitored and addressed as: prolonged ileus, wound sepsis as major and minor wound infection, intra-abdominal sepsis as pelvic abscess and faecal fistula. Conclusion: As the time course increases from the initiation of the first symptoms to the definitive management, the complication rate increases and acutely inflamed appendicitis gradually converts to more lethal forms.TAJ 2017; 30(1): 42-48

Impact of summer season on pre-hospital time delays in women and men undergoing primary percutaneous coronary intervention

BackgroundPre-hospital delays have been associated with poor outcomes in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). It is currently unknown how environmental variables affect treatment delays in these patients. Methods and resultsThe association between environmental variables, time to treatment including transportation times and adverse in-hospital events was assessed in 1828 consecutive patients with STEMI undergoing primary PCI between 2010 and 2014 in the Montreal metropolitan area. Median[Q1;Q3] total ischemia time was significantly longer during summer season (April–September) as compared to winter season (October–March, 201[140;305] min vs 187[126;266] min, p = 0.022). This difference between seasons was due to a significant increase in median decision time to seek treatment for symptoms during summer (90[46;185] min vs 78[40;156], p = 0.004). The former peaked during July and August and was most pronounced in men. Hence, outside temperature and summer season were identified as strong predictors of prolonged decision time in patients with STEMI (p < 0.001 and p = 0.002, respectively). Transportation times slightly increased during winter season and snow fall, this difference, however, was not significant (p = 0.46). A significant increase in in-hospital adverse outcomes following primary PCI was observed during summer season as compared to winter season (7.2% vs 4.8%, p = 0.032). Accordingly, multivariate logistic regression models adjusted for baseline variables identified summer season as a strong predictor of periprocedural adverse events (OR 1.83, 95% CI 1.2–3.11, p = 0.037). ConclusionContrary to our initial hypothesis, pre-hospital delays in patients with STEMI are considerably longer and associated with adverse in-hospital outcomes during summer season. Considering the consequences of global warming, it is imperative that educational efforts targeting patients' perception are implemented to counter treatment delays.

Patient-reported symptoms improve prediction of acute coronary syndrome in the emergency department.

Early diagnosis is critical in the management of patients with acute coronary syndrome (ACS), particularly ST-elevation myocardial infarction (STEMI), because effective therapies are time-dependent. Aims of this secondary analysis were to determine: (i) the prognostic value of symptoms for an ACS diagnosis in conjunction with electrocardiographic (ECG) and troponin results; and (ii) if any of 13 symptoms were associated with prehospital delay in those presenting to the emergency department (ED) with potential ACS. Patients receiving a cardiac evaluation in the ED were eligible for the study. Thirteen patient-reported symptoms were assessed in triage. Prehospital delay time was calculated as the time from symptom onset until registration in the ED. A total of 1,064 patients were enrolled in five EDs. The sample was 62% male, 70% white, and had a mean age of 60.2 years. Of 474 participants diagnosed with ACS, 118 (25%) had STEMI; 251 (53%) had non-ST elevation myocardial infarction (NSTEMI); and 105 (22%) had unstable angina. Sweating (OR = 1.42 CI [1.01, 2.00]) and shoulder pain (OR = 1.64 CI [1.13, 2.38]) added to the predictive value of an ACS diagnosis when combined with ECG and troponin results. Shortness of breath (OR = 0.71 CI [0.50, 1.00]) and unusual fatigue (OR = 0.60 CI [0.42, 0.84]) were predictive of a non-ACS diagnosis. Sweating predicted shorter prehospital delay (HR = 1.35, CI [1.10, 1.67]); shortness of breath (HR = 0.73 CI [0.60, 0.89]) and unusual fatigue (HR = 0.72, CI [0.57, 0.90]) were associated with longer prehospital delay. Patient-reported symptoms are significantly associated with ACS diagnoses and prehospital delay. Sweating and shoulder pain combined with ECG signs of ischemia may improve the timely detection of ACS in the ED.

Impact of Reducing Pre-Hospital Delay in Response to Heart Attack Symptoms in Australia

This research estimates the broader socioeconomic impacts of reducing pre-hospital delay times across Australia in patients with heart attack symptoms. A cost benefit analysis (CBA) was undertaken to demonstrate the costs and benefits of a public awareness/education campaign to reduce pre-hospital delay time from 5.2hours (Base Case) to 4.1hours (Scenario 1) and 2.0hours (Scenario 2). All assumptions underlying the CBA are supported by academic literature. Financial impacts considered include campaign/public education costs, direct inpatient costs and long-term health care costs. Socioeconomic impacts considered include burden of disease, productivity losses, informal care costs and net deadweight loss. The campaign is expected to generate an additional net benefit of $41.2-139.1 million in comparison to the Base Case, resulting in a benefit cost ratio (BCR) of 3.23-5.06. Disability Adjusted Life Years (DALYs) reduced by 6,046-7,575 years. This research illustrates that an investment in public awareness/education campaign can generate considerable benefits, more than offsetting the costs associated with the campaign and keeping people living longer such as ongoing health care costs. However, significant effort, supplementary strategies and sustained investment will be required to ensure the impact and benefit is sustained over the long term.

Generalization of the right acute stroke promotive strategies in reducing delays of intravenous thrombolysis for acute ischemic stroke: A meta-analysis.

The generalization of successful efforts for reducing time delays in intravenous thrombolysis (IVT) could help facilitate its utility and benefits in acute ischemic stroke (AIS) patients.We searched the PubMed and Embase databases for articles reporting interventions to reduce time delays in IVT, published between January 1995 and September 2017. The IVT rate was chosen as the primary outcome, while the compliance rates of onset-to-door time (prehospital delay) and door-to-needle time (in-hospital delay) within the targeted time frame were the secondary outcomes. Interventions designed to reduce prehospital, in-hospital, or total time delays were quantitatively described in meta-analyses. The efficacy of postintervention improvement was illustrated as odds ratios (ORs) and 95% confidence intervals (95% CIs).In total, 86 papers (17 on prehospital, 56 on in-hospital, and 13 on total delay) encompassing 17,665 IVT cases were enrolled, including 28 American, 23 Asian, 30 European, and 5 Australian studies. The meta-analysis revealed statistically significant improvement in promoting IVT delivery after prehospital improvement interventions with an OR of 1.45 (95% CI, 1.23-1.71) for the new transportation protocol, 1.38 (95% CI, 1.11-1.73) for educational and training programs, and 1.83 (95% CI, 1.44-2.32) for comprehensive prehospital stroke code. The benefits of reducing in-hospital delay were much greater in developed western countries than in Asian countries, with ORs of 2.90 (95% CI, 2.51-3.34), 2.17 (95% CI, 1.95-2.41), and 1.89 (95% CI, 1.74-2.04) in American, European, and Asian countries, respectively. And telemedicine (OR, 2.26; 95% CI, 2.08-2.46) seemed to work better than pre-notification alone (OR, 1.94; 95% CI, 1.74-2.17) and in-hospital organizational improvement programs (OR, 2.10; 95% CI, 1.97-2.23). Mobile stroke treatment unit and use of a comprehensive stroke pathway in the pre- and in-hospital settings significantly increased IVT rates by reducing total time delay, with ORs of 2.01 (95% CI, 1.60-2.51) and 1.77 (95% CI, 1.55-2.03), respectively.Optimization of the work flow with organizational improvement or novel technology could dramatically reduce pre- and in-hospital time delays of IVT in AIS. This study provided detailed information on the net and quantitative benefits of various programs for reducing time delays to facilitate the generalization of appropriate AIS management.

Gender disparities in first medical contact and delay in ST-elevation myocardial infarction: a prospective multicentre Swedish survey study

ObjectivesCompare gender disparities in ST-elevation myocardial infarction (STEMI) regarding first medical contact (FMC) and prehospital delay times and explore factors associated with prehospital delay in men and women separately.DesignCross-sectional study...

ANALISIS FAKTOR YANG MEMPENGARUHI “PREHOSPITAL DELAY TIME” PADA PASIEN NON-ST ELEVATION MYOCARDIAL INFARCTION (NSTEMI)

Background: AMI is the leading cause of morbidity and disability among Indonesian population. In referrals centre hospital, in-hospital mortality of NSTEMI is equal or even exceeds STEMI, increased from 17% to 21% during 12 months. Prehospital delay is an important cause of increasing early and also late mortality in NSTEMI.&#x0D; Objective: We investigated factors associated with prolonged prehospital delay in patients with NSTEMI.&#x0D; Method: In this cross-sectional study design, data were analyzed by chi-square and one-way ANOVA using SPSS 20 and data were collected from 50 patients with NSTEMI using patient’s medical notes and semi-structured interviews. Patients were pain-free and hemodynamically stable at the time of interview. Data were collected on the time from the onset of chest pain to hospital admission.&#x0D; Results: Mean of prehospital delay times were 7,89±1,44 hours. The predictor were singularly significantly associated with prolonged prehospital delay were self medication and health care seeking pattern. Traditional healers had longest prehospital delay time (24,30±2,65hours). Most of the people in Java from various social strata still believe in traditional healers (dukun) to treat their disease.&#x0D; Conclusion: Health care providers can educate the public on NSTEMI to enable them recognize the signs and symptoms of NSTEMI correctly and realize the benefits of early treatment.&#x0D; &#x0D; Keyword: Prehospital delay time and NSTEMI

Predictors for prehospital time delay in patients with acute stroke in Germany (P1.213)

Predictors for prehospital time delay in patients with acute stroke in Germany (P1.213)

Guideline-adherence regarding critical time intervals in the German Chest Pain Unit registry.

Since 2008, the German Cardiac Society certified 256 Chest Pain Units (CPUs). Little is known about adherence to recommended performance measures in patients with suspected acute coronary syndrome (ACS) presenting to CPUs. We investigated guideline-adherence regarding critical time intervals and selected performance measures in German Chest Pain Units. From 2008 to 2014, 23,804 consecutive patients with suspected ACS were prospectively enrolled in the Chest Pain Unit registry of the German Cardiac Society. Median time from symptom onset to first medical contact was 2 h in patients with ST-elevation myocardial infarction (STEMI) and 4 h in patients with unstable angina and non-STEMI (NSTEMI). In patients with STEMI, median time from hospital admission to percutaneous coronary intervention (PCI) was 40 min and median time from first medical contact to PCI was 1 h 35 min. Primary PCI was performed in 94.7% of patients with STEMI, 70.0% of patients with NSTEMI and 37.4% of patients with unstable angina. PCI was performed during the first 24 h in 79.5% of patients with NSTEMI and the first 72 h in 89.0% of patients with unstable angina. Electrocardiograms were performed in 99.5% after a median of 6 min after admission and obtained within 10 min in 71%. Interestingly, 56.1% of patients were found to have non-ACS diagnoses, underlining the importance of access to additional diagnostic modalities including echocardiography, stress testing or computed tomography. Guideline-adherence regarding critical time intervals and primary PCI rates is good in German Chest Pain Units. More than half of patients admitted with suspected ACS had non-ACS diagnoses. Improvements in pre-hospital time delays through public awareness programmes are warranted.

Patient knowledge on stroke risk factors, symptoms and treatment options.

BackgroundPublic campaigns focus primarily on stroke symptom and risk factor knowledge, but patients who correctly recognize stroke symptoms do not necessarily know the reason for urgent hospitalization. The aim of this study was to explore knowledge on stroke risk factors, symptoms and treatment options among acute stroke and transient ischemic attack patients.MethodsThis prospective study included patients admitted to the stroke unit at the Department of Neurology, Akershus University Hospital, Norway. Patients with previous cerebrovascular disease, patients receiving thrombolytic treatment and patients who were not able to answer the questions in the questionnaire were excluded. Patients were asked two closed-ended questions: “Do you believe that stroke is a serious disorder?” and “Do you believe that time is of importance for stroke treatment?”. In addition, patients were asked three open-ended questions where they were asked to list as many stroke risk factors, stroke symptoms and stroke treatment options as they could.ResultsA total of 173 patients were included, of whom 158 (91.3%) confirmed that they regarded stroke as a serious disorder and 148 patients (85.5%) considered time being of importance. In all, 102 patients (59.0%) could not name any treatment option. Forty-one patients (23.7%) named one or more adequate treatment options, and they were younger (p<0.001) and had higher educational level (p<0.001), but had a nonsignificant shorter prehospital delay time (p=0.292).ConclusionThe level of stroke treatment knowledge in stroke patients seems to be poor. Public campaigns should probably also focus on information on treatment options, which may contribute to reduce prehospital delay and onset-to-treatment-time.

Impact of Prehospital Triage Scales to Detect Large Vessel Occlusion on Resource Utilization and Time to Treatment.

Prehospital stroke severity scales may help to triage acute ischemic stroke patients with large vessel occlusion (LVO) for direct transportation to a comprehensive stroke center. The impact on resource use and time to reperfusion treatment for patients with and without LVO is unknown. Based on empirical distributions of stroke symptom severity, prehospital delay times, and stroke symptom severity-dependent likelihood of LVO, we simulate prehospital incidents of stroke-like symptoms in abstract geographical environments to estimate the impact of prehospital triage strategies based on different cutoffs of the rapid arterial occlusion evaluation scale. Compared with transporting each patient to the nearest stroke center, implementation of a prehospital triage strategy based on a rapid arterial occlusion evaluation scale cutoff score ≥5 is associated with more patients with suspected acute stroke at comprehensive stroke centers and less patients at primary stroke centers (+11.7% [95% confidence interval: +8.1% to +15.3%] and -18.4% [-19.1% to -17.7%], respectively). Mean time to groin puncture is reduced by 29.6 minutes (-35.2 to -24.7 minutes) while mean time to thrombolysis does not change significantly (±0.0 minutes [-0.3 to +0.3 minutes]). The total number of secondary transfers is reduced by 60.9% (-62.8% to -59.0%); mean time of ambulance use per patient is unchanged. Results are robust with regards to variation in model parameters. Implementation of prehospital triage based on stroke severity scales would have strong impact on patient flow and distribution. The benefit of earlier thrombectomy for patients with LVO may outweigh the harm associated with delayed access to thrombolysis for some patients without LVO. Randomized trials using clinical stroke severity scales as a triage tool are needed to confirm our findings.

THE CORRELATION OF HEALTH SEEKING BEHAVIOR AND TRANSPORTATION MODE WITH PREHOSPITAL DELAY TIME IN PATIENTS WITH ACUTE CORONARY SYNDROME AT EMERGENCY DEPARTMENT OF REGIONAL PUBLIC HOSPITAL OF dr. T.C. HILLERS

Emergency conditions of the acute coronary syndrome (ACS) requires rapid and precise management. Prehospital delay time can result in deaths attributed to health seeking behavior and transportation mode. This research aimed to analyze the correlation of health seeking behavior and transportation mode with prehospital delay time in patients with Acute Coronary Syndrome at Emergency Department of Regional Public Hospital of dr. T.C. Hillers. The research design was observational analytic with cross sectional approach. The sample was 42 respondents obtained by using consecutive sampling. Data were collected with an interview in April-June 2017, then analyzed with univariate analysis and bivariate (Fisher test). The results showed that the majority of health seeking behavior of ACS patients was delayed to hospital (76.2%) and the mode of transportation used was public transportation (31%). Prehospital delay time most of which arrived late (&gt; 120 min) (61.9%). Result of fisher test show there is correlation of health seeking behavior and transportation mode with prehospital delay time in patients with Acute Coronary Syndrome at Emergency Department of Regional Public Hospital of dr. T.C. Hillers. The results indicate the importance of improving patient referral systems, provide health counseling, provide village ambulances, support and organize Emergency Medical Services.

Relationship between pre-hospital delay and health belief in patients with colorectal cancer

Objective To describe the current situation of pre-hospital delay and belief in patients with colorectal cancer and explore the relationship between them. Methods With convenient sampling methods,totally 385 patients with colorectal cancer were recruited from January to June 2016. Patients with colorectal cancer were investigated using a general data survey questionnaire, visit situation questionnaire and the Champion Health Belief Model Scale. Results The median pre-hospital delay time was 3.00 months. The rate of pre-hospital delay was 43.1%(166/385). The score of the overall belief was (119.52±12.62) points. The two dimensions of susceptibility and perceived severity scored lower, and the two dimensions of health motivation and perceived therapeutic benefits scored higher. The belief was negatively correlated with the pre-hospital delay among colorectal cancer patients (r=-0.737, P<0.01). Conclusions Pre-hospital delay occurred among patients with colorectal cancer is severe. Patients with a higher level of belief have shorter pre-hospital delay. It′s important to improve the level of belief of susceptibility and perceived severity and reduce the time of pre-hospital delay to improve outcomes in patients with colorectal cancer. Key words: Colorectal neoplasms; Pre-hospital delay; Health belief; Attitude to

Interventions to increase patient and family involvement in escalation of care for acute life-threatening illness in community health and hospital settings

Interventions to increase patient and family involvement in escalation of care for acute life-threatening illness in community health and hospital settings

Comparison of Delay Times Between Symptom Onset of an Acute ST-elevation Myocardial Infarction and Hospital Arrival in Men and Women

Early administration of reperfusion therapy in acute ST-elevation myocardial infarctions (STEMI) is crucial to reduce mortality. Although female sex and old age are key factors contributing to an inadequate long prehospital delay time, little is known whether women ≥65 years are a particular risk population. Hence, we studied the interaction of sex and age (<65 years or ≥65 years) and the contribution of chest pain to delay time during STEMI. Bedside interview data were collected in 619 STEMI patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Sex and age group stratification disclosed an excess delay risk for women ≥65 years, accounting for a 2.39 (95% confidence interval (CI) 1.39 to 4.10)-fold higher odds to delay longer than 2 hours compared with all other patient groups including younger women (p ≤0.002). Median delay time was 266 minutes in women ≥65 years and 148 minutes in younger women (p <0.001). Chest pain during STEMI had the lowest frequency both in women (81%) and men ≥65 years (83%) and the highest frequency (95%) in younger women. Experiencing non-chest pain was 2.32-fold (95% CI, 1.20 to 4.46, p <0.05) higher in women ≥65 years than in all other patients. Mediation analysis disclosed that the effect accounted for only 9% of the variance. Age specific educational strategies targeting women ≥65 years at risk are urgently needed. To tailor adequate strategies, more research is required to understand age- and sex driven barriers to timely identification of ischemic symptoms.

Skubios medicinos pagalbos paieškos delsimas susirgus ūminiu miokardo infarktu

Ūminis miokardo infarktas – viena iš pagrindinių mirties priežasčių Lietuvoje. Gydymo sėkmė priklauso nuo to, kaip greitai atkuriama miokardo kraujotaka. Tyrimo tikslas – nustatyti, kiek pacientai delsia nuo ūminio miokardo infarkto simptomų atsiradimo iki sprendimo kreiptis medicinos pagalbos, identifikuoti rizikos faktorius, susijusius su delsimu. Atliktas prospektyvinis anketinis tyrimas individualiai apklausiant 100 pacientų, susirgusių ūminiu miokardo infarktu. Galutinėje analizėje dalyvavo 94. Pacientai suskirstyti į dvi grupes pagal laiką, kuris praėjo nuo simptomų atsiradimo iki sprendimo kreiptis medicinos pagalbos: I (N=56) grupė - ≤6 val., II (N=38) grupė - &gt;6 val. Darbo rezultatai: laiko, praėjusio nuo simptomų atsiradimo iki sprendimo kreiptis medicinos pagalbos mediana (25; 75 procentilės) buvo 235 (89; 728) min. Nustatyti šie rizikos veiksniai, kurie lėmė ilgesnę delsimo trukmę: gyvenimas kaime, lyginant su miestu (GS= 3,611; 95% PI=1,311 – 9,955; p=0,044), simptomų pasireiškimas naktį (GS=2,658; 95% PI=0,998 – 7,078; p=0,046), tikėjimas, jog atsiradę simptomai susiję su kita liga (GS=3,64; 95% PI=1,29 – 10,272; p=0,012). Išvados: pacientai, susirgę ūminiu miokardo infarktu, per ilgai nesikreipė medicinos pagalbos; nustatyti šie rizikos veiksniai, lemiantys ilgesnę delsimo trukmę: gyvenimas kaime, simptomų pasireiškimas naktį, tikėjimas, jog simptomai susiję su kita liga. Būtina gerinti visuomenės žinias apie ūminio miokardo infarkto klinikinius simptomus.

Interpretation of symptoms as a cause of delays in patients with acute myocardial infarction, Istanbul, Turkey.

This cross-sectional study aimed to assess interpretation of symptoms as a cause of delays in patients with acute myocardial infarction (AMI). It was conducted at a university hospital in Istanbul, Turkey. The sample included 93 patients: 73 male, mean age 57.89 (12.13) years. Prehospital delay time ranged from 15 minutes to 10 days, with a median of 2 hours (interquartile range: 9.50). Patients waited for pain to go away (48.4%) and tried to calm down (39.8%). Most patients attributed AMI-related symptoms to a reason other than heart disease. In a multivariate logistic regression analysis, the type of AMI was classified based on electrocardiography findings (odds ratio 5.18, 95% confidence interval: 1.69-15.91, P=0.004) and was independently associated with a long prehospital delay time, indicating that patients with ST segment elevation MI would seek early medical care. Misinterpretation of symptoms and misconceptions about emergency treatment during AMI cause delays in admission and may affect treatment.

Changes in Quality of Prehospital Care and Time Delays in Acute Stroke in Tallinn, Estonia from 2005 to 2016

Changes in Quality of Prehospital Care and Time Delays in Acute Stroke in Tallinn, Estonia from 2005 to 2016

Can we rely on out-of-hospital blood samples? A prospective interventional study on the pre-analytical stability of blood samples under prehospital emergency medicine conditions

BackgroundPrehospital intravenous access provides the opportunity to sample blood from an emergency patient at the earliest possible moment in the course of acute illness and in a state prior to therapeutic interventions. Our study investigates the pre-analytical stability of biomarkers in prehospital emergency medicine and will answer the question whether an approach of blood sampling out in the field will deliver valid laboratory results.MethodsWe prepared pairs of blood samples from healthy volunteers and volunteering patients post cardio-thoracic surgery. While one sample set was analysed immediately, the other one was subjected to a worse-than-reality treatment of 60 min time-lapse and standardized mechanical forces outside of the hospital through actual ambulance transport. We investigated 21 parameters comprising blood cells, coagulation tests, electrolytes, markers of haemolysis and markers of cardiac ischemia. Bland-Altman analysis was used to investigate differences between test groups. Differences between test groups were set against the official margins of test accuracy as given by the German Requirements for Quality Assurance of Medical Laboratory Examinations.ResultsAgreement between immediate analysis and our prehospital treatment is high as demonstrated by Bland-Altman plotting. Mechanical stress and time delay do not produce a systematic bias but only random inaccuracy. The limits of agreement for the tested parameters are generally within clinically acceptable ranges of variation and within the official margins as set by the German Requirements for Quality Assurance of Medical Laboratory Examinations.DiscussionWe subjected blood samples to a standardized treatment marking a worse-than-reality scenario of prehospital time delay and transport. Biomarkers including indicators of myocardial ischemia showed high pre-analytical stability.ConclusionWe conclude the validity of blood samples from a prehospital environment.

Pre-hospital and hospital delay in patients with non-ST elevation acute coronary syndromes in tertiary care.

BackgroundEarly presentation is desirable in all cases of acute prolonged chest pain. Causes of delayed presentation vary widely across geographic regions because of different patients' profile and different healthcare capabilities.ObjectivesTo detect causes of delay of Non-ST elevation acute coronary syndrome (NSTE-ACS) patients in our country.MethodsPatients admitted with NSTE-ACS were included. We recorded the time delay between the onsets of acute severe symptoms till their arrival to the hospital (Pre-hospital delay). We also recorded the time delay between the arrival to hospital and the institution of definitive therapy (hospital delay). Causes of pre-hospital delay are either patient- or transportation-related, while hospital delay causes are either staff- or system-related.ResultsWe recruited 315 patients, 200 (63.5%) were males, 194 (61.6%) hypertensives, 180 (57.1%) diabetics, 106 (33.7%) current smokers and 196 (62.2%) patients had prior history of cardiac diseases. The mean pre-hospital delay time was 8.7 ± 9.7 h. Sixty-six percent of this time was due to patient-related causes and 34% of pre-hospital delay time was spent in transportation. The mean hospital delay time was 2.3 ± 0.95 h. In 89.8% of cases, the hospital delay was system-related while in 10.2% the reason was staff-related. The mean total delay time to definitive therapy was 11.0 ± 9.8 h.ConclusionPre-hospital delay was mainly patient-related. Hospital delay was mainly related to healthcare resources. Governmental measures to promote ambulance emergency services may reduce the pre-hospital delay, while improving the utilization of healthcare resources may reduce hospital delay.