Prehospital Delay Research Articles

Characterization of prehospital time delay in primary percutaneous coronary intervention for acute myocardial infarction: analysis of geographical infrastructure-dependent and -independent components

BackgroundPrehospital delay in reaching a percutaneous coronary intervention (PCI) facility is a major problem preventing early coronary reperfusion in patients with ST-elevation myocardial infarction (STEMI). The aim of this study was to identify modifiable factors that contribute to the interval from symptom onset to arrival at a PCI-capable center with a focus on geographical infrastructure-dependent and -independent factors.MethodsWe analyzed data from 603 STEMI patients who received primary PCI within 12 h of symptom onset in the Hokkaido Acute Coronary Care Survey. We defined onset-to-door time (ODT) as the interval from the onset of symptoms to arrival at the PCI facility and we defined door-to-balloon time (DBT) as the interval from arrival at the PCI facility to PCI. We analyzed the characteristics and factors of each time interval by type of transportation to PCI facilities. In addition, we used geographical information system software to calculate the minimum prehospital system time (min-PST), which represents the time required to reach a PCI facility based on geographical factors. We then subtracted min-PST from ODT to find the estimated delay-in-arrival-to-door (eDAD), which represents the time required to reach a PCI facility independent of geographical factors. We investigated the factors related to the prolongation of eDAD.ResultsDBT (median [IQR]: 63 [44, 90] min) was shorter than ODT (median [IQR]: 104 [56, 204] min) regardless of the type of transportation. However, ODT was more than 120 min in 44% of the patients. The min-PST (median [IQR]: 3.7 [2.2, 12.0] min) varied widely among patients, with a maximum of 156 min. Prolongation of eDAD (median [IQR]: 89.1 [49, 180] min) was associated with older age, absence of a witness, onset at night, no emergency medical services (EMS) call, and transfer via a non-PCI facility. If eDAD was zero, ODT was projected to be less than 120 min in more than 90% of the patients.ConclusionsThe contribution of geographical infrastructure-dependent time in prehospital delay was substantially smaller than that of geographical infrastructure-independent time. Intervention to shorten eDAD by focusing on factors such as older age, absence of a witness, onset at night, no EMS call, and transfer via a non-PCI facility appears to be an important strategy for reducing ODT in STEMI patients. Additionally, eDAD may be useful for evaluating the quality of STEMI patient transport in areas with different geographical conditions.

Analysis of pre-hospital delay in Chinese patients with diabetic foot ulcers: Based on 46 cases.

To study the causes of pre-hospital delay in Chinese patients with diabetic foot ulcers (DFUs). A retrospective study, investigating a case series of 46 DFUs treated at a single hospital, was conducted to evaluate wound condition, wound treatment, costs, and patients' complete medical records, and analyse the reasons causing the pre-hospital delay. We assessed 46 DFUs aged between 53 and 92 years old. The average pre-hospital delay was 5months, with nearly 20% being delayed for more than 1year. The average length of hospital stay in China was 21 days, with an average cost of $8672. Recurrence rate of DFUs was 21%, and three patients were recommended to transfer to upper-level hospital. Besides, the intervention was limited and homogenous and medical records were incomplete. Medical service users' limited understanding of diseases, high costs that patients need to afford, and unsatisfactory treatment by medical service providers are the main reasons for patients' delay in seeking treatment. Recommendations are offered to reduce the pre-hospital delay of Chinese patients with DFUs.

Trends in Prehospital Visits as a Cause of Delayed Admission in Korean Stroke Patients over a 10-Year Period: A National Health Insurance Claims Data Study.

A prehospital delay from symptom onset to hospital arrival resulted in stroke-related complications or in-hospital deaths in acute stroke patients. We aimed to investigate trends in prehospital visits as a cause of prehospital delay using data from the Korean Health Insurance Service. This nationwide, population-based, retrospective cohort study included 524,524 newly-diagnosed stroke patients admitted via the emergency departments of secondary and tertiary hospitals. We obtained the prehospital visits rate from 2010 to 2019 and identified the related characteristics. Prehospital visits were observed in 111,465 patients (21.3%). The prehospital visits rate decreased from 25.1% in 2010 to 17.8% in 2019, but the number of patients increased from 11,255 cases in 2010 to 11,747 cases in 2019. Fortunately, the rate of delayed admission for more than one day decreased from 26.7% to 21.3%. However, 10.4% of patients were diagnosed more than two days later. Young, females, or patients with higher income status and living in low urbanization areas exhibited a higher rate of prehospital visits. Prehospital visits in Korean stroke patients decreased from 25.1% in 2010 to 17.8% in 2019. However, more than 10,000 patients still visited other medical institutions before admission to treatment.

Abstract Number ‐ 31: No Mercy on Stroke Campaign: The Use of Pop Culture Icons to Raise Stroke Awareness

Introduction About 24–46% of acute ischemic strokes are due to large vessel occlusions1, however only a small fraction2,3 of thrombectomy eligible patients undergo emergent clot retrieval. Despite advances in thrombolytics and endovascular interventions, many patients are not candidates for emergent therapies due to delay in patient presentation, prehospital delay, triage delay and limited access to care. No Mercy on Stroke (NMOS) campaign aims to raise public stroke awareness by increasing social media footprint. Thereby enabling the general population with tools for earlier symptom detection, seeking rapid medical attention and fighting for legislature to improve prehospital networks. Methods Society of Vascular and Interventional Neurology (SVIN) launched NMOS campaign just prior to World Stroke Day (WSD) on October 25th, 2021 via Twitter. Pop culture icon and martialist Martin Kove launched the campaign as Sensei Kreese from the movie Cobra Kai in a video encouraging viewers to “strike fast and strike hard” when treating stroke. SVIN and Kove urged followers to spread the fight against stroke by sharing karate poses with hashtag #NoMercyOnStroke. Metrics such as social media reach, impact, location and others were extracted via Tweepsmap and Tweetbinder from October 25th, 2021 to August 20th, 2022. Results #NoMercyOnStroke was tweeted 716 times by 211 contributors4 across 19 countries and 77 cities5 for a potential reach of 374,200 people and potential impact of 2,051,908 people4. Tweet breakdown consisted of 126 original tweets and 590 retweets4. Engagements were primarily likes recorded at 2437, and followed by 97 replies and 55 quotes. Activity timeline was highest during week of WSD and accounted for majority exposure, however, there was another small peak in activity one month later. Top 3 countries involved were USA, Canada and India although USA accounted for 90.4% of all activity. Other countries include Mexico, Colombia, Spain, Egypt, Croatia, UK, Saudi Arabia, Kenya, Libya, Vietnam, Italy, Cuba, France, Peru, Chile and Venezuela5. Top associated hash tags were #worldstrokeday, #WSD and #alz0212465. Conclusions Use of pop culture icon as an advocate for stroke awareness greatly increased reach and impression of the NMOS campaign by touching nearly two million followers. Compared to raw data across three social media platforms for a similar campaign by Mission Thrombectomy called #BEFASTChallenge, #NoMercyOnStroke had exponentially more engagement with almost double the original posts and triple the retweets. Still, activity was concentrated around initial launch with minimal tail in the activity timeline. The overall impact of such campaigns on the end‐goal of decreasing the ratio of eligible thrombectomies to number of thrombectomies performed is yet to be uncovered. However, it is clear that larger campaigns involving celebrity influencers and community outreach are imperative to keeping the momentum of raising stroke awareness.

Antivenom availability, delays and use in Australia.

Antivenom is the main treatment for snake envenoming and there are ongoing concerns about availability in resource poor regions of the world. However, effective antivenom treatment for snake envenoming requires more than improved availability of safe and efficacious antivenoms. Most importantly, antivenom must be administered as early as possible, and within 2-6h of the bite in Australia. At the same time, it is also important that antivenom not be given to all patients indiscriminately with a suspected snakebite, because of the risk of anaphylaxis. Delays in the administration of antivenom are a significant impediment to effective antivenom treatment and can be divided into pre-hospital and in-hospital delays. These range from delays due to remoteness of snakebite, to delays in diagnosis and administration of antivenom once in hospital. In Australia, antivenom is readily available in most hospitals, and a large portion of patients present to hospital within 2h of the bite. However, there is on average a further delay of 2.5h before antivenom is administered. Early diagnosis with accurate bedside tests and rapid clinical assessment of patients with snakebite are key to improving the effective use of antivenom.

Less Help-Seeking Behaviour in Female Patients Exhibiting Stroke or TIA - Related Symptoms

Several studies have shown sex differences regarding help-seeking behaviour in stroke and transient ischemic attack [TIA] patients. Women are less likely to perceive their symptoms as requiring immediate hospital care. They are also more inclined to involve friends and family in decision-making and help-seeking. Delaying transport to the hospital is partly due to behavioural and socio-demographic factors of female patients. These impact help-seeking behaviour and prolong prehospital delay, which may affect patient outcomes. We present a 69-year-old woman exhibiting neurological symptoms indicative of a cerebrovascular event, refusing to go to the hospital. The Emergency medical service [EMS] team made the initial medical assessment, outlining the need for immediate transport. Our patient did not view her symptoms as worrying but finally agreed to go to the hospital. She was persuaded by her children, who had an active role in the patient’s decision-making process. Factors that affected help-seeking behaviour and prehospital delay were analysed, accompanied by a review of literature related to the subject.

Reasons withholding intravenous thrombolysis for acute ischemic stroke in an Indonesian Tertiary Center

BackgroundIntravenous thrombolysis is the current therapy of choice in patients with acute ischemic stroke (AIS). While highly effective, the rate at which the procedure is employed is low. Studies evaluating the causes withholding thrombolytic treatment in developing nations remain scarce. We aim to determine the factors withholding thrombolytic treatment in AIS patients.MethodsThis is a retrospective study of AIS patients at Siloam Hospitals Lippo Village, Indonesia, in a 10-month period between April 2019 to February 2020. Patient data were collected from the medical records.ResultsOne hundred and forty-five cases of AIS were found within a 10-month period (April 2019 to February 2020). Thrombolysis was performed in 6.90% of all patients with AIS (21.28% when adjusted for eligible patients with onset ≤ 4.5 h). Prehospital delay exceeding 4.5 h was the most common cause of withholding thrombolytic treatment (68.28% of patients present above 4.5 h or with unknown onset). Among patients presenting ≤ 4.5 h, causes withholding thrombolysis include clinical improvement (35.14%), mild non-disabling symptoms (32.43%), patient/family refusal (18.92%), extensive infarction (5.41%), seizures at onset (2.7%), as well as history of acute bleeding diathesis (2.7%) and gastrointestinal bleeding (2.7%).ConclusionsPrehospital delay constitutes the primary obstacle toward receiving thrombolytic therapy for AIS, especially in developing countries. Among patients with onset below 4.5 h, other notable causes include clinical improvement, mild non-disabling symptoms, and patient/family refusal. Of note, the rate of patient/family refusal in our study was much higher compared to previous findings, which may reflect possible socio-economic, communication, or educational issues.

Pre- and in-hospital delays in the use of thrombolytic therapy for patients with acute ischemic stroke in rural and urban Egypt.

Reducing pre- and in-hospital delays plays an important role in increasing the rate of intravenous thrombolysis (IVT) in patients with acute ischemic stroke. In Egypt, the IVT rate has increased steadily but is still far away from an ideal rate. The study aimed to investigate the factors associated with pre- and in-hospital delays of IVT among patients with acute ischemic stroke coming from urban and rural communities. This prospective, multicenter, observational cohort study was conducted from January 2018 to January 2019. Patients with acute ischemic stroke, who did not receive IVT, were included in the study. Patients were recruited from three large university stroke centers in Egypt, Assiut (south of Egypt), Tanta (north of Egypt), both serving urban and rural patients, and the University Hospital in Cairo (capital city), only serving an urban community. All participants underwent the National Institutes of Health Stroke Scale and full neurological assessment, urgent laboratory investigations, and computed tomography or magnetic resonance imaging to confirm the stroke diagnosis. The patients were subjected to a structured questionnaire that was designed to determine the parameters and time metrics for the pre- and in-hospital delays among patients from rural and urban regions. A total of 618 patients were included in the study, of which 364 patients (58.9%) lived in rural regions and 254 (41.1%) in urban regions. General demographic characteristics were similar between both groups. Approximately 73.3% of patients who arrived within the therapeutic time window were urban patients. The time from symptom onset till hospital arrival (onset to door time, ODT) was significantly longer among rural patients (738 ± 690 min) than urban patients (360 ± 342 min). Delayed onset to alarm time (OAT), initial misdiagnosis, and presentation to non-stroke-ready hospitals were the most common causes of pre-hospital delay and were significantly higher in rural patients. For patients arriving within the time window, the most common causes of in-hospital delays were prolonged laboratory investigations and imaging duration. The limited availability of stroke-ready hospitals in rural Egypt leads to delays in stroke management, with subsequent treatment inequality of rural patients with acute stroke.

Age and geographic disparities in acute ischaemic stroke prehospital delays in China: a cross-sectional study using national stroke registry data

Stroke has been the leading cause of death in China for decades. The extremely low intravenous thrombolysis rate is largely due to the prehospital delays that make patients ineligible for the time-sensitive therapy. Limited studies evaluated prehospital delays across China. We investigated prehospital delays in the stroke population across China and the associated age, rurality, and geographic disparities. A cross-sectional study design was employed using the Bigdata Observatory platform for Stroke of China in 2020, the nationwide, prospective, multicentre registry of patients with acute ischaemic stroke (AIS). Mixed-effect regression models were used to account for the clustered data. The sample contained 78,389 AIS patients. The median onset-to-door (OTD) time was 24h, with only 11.79% (95% confidence interval [CI]: 11.56-12.02%) patients arriving at hospitals within 3h. About 12.43% (95% CI: 12.11-12.74%) of patients 65 years or older arrived at hospitals within 3h, which was significantly higher than the young and middle-aged patients (11.03%; 95% CI: 10.71-11.36%). After controlling for potential confounders, young and middle-aged patients were less likely to present to hospitals within 3h (adjusted odds ratio: 0.95; 95% CI: 0.90-0.99) compared to patients 65 years or older. The 3-h hospital arrival rate was the highest in Beijing (18.40%, 95% CI: 16.01-20.79%), which was almost 5 times higher than that in Gansu (3.45%, 95% CI: 2.69-4.20%). The arrival rate in urban areas was almost 2 times higher than that in rural areas (13.35% versus. 7.66%). We found that the low rates of timely arrival at hospitals after a stroke is more salient in the younger population, rural settings, or those residing in less developed geographic regions. This study calls for more tailored interventions focusing on younger people, rural areas, and less developed geographic regions. The National Natural Science Foundation of China; CIHR, Grant/Award Number: 81973157, PI: JZ. Natural Science Foundation of Shanghai; CIHR, Grant/Award Number: 17dz2308400, PI: JZ. Funding from the University of Pennsylvania; Grant/Award Number: CREF-030, PI: RL.

Faktor Keterlambatan Pada Pasien Kanker Payudara Yang Berobat Di Rsucm Aceh Utara Tahun 2020 - 2021

cancer is a malignant tumor that begins in the cells in the breast derived from normal cells in the breast can come from the mammary glands, milk ducts, or supporting tissues such as fat. Delay in cancer management can be caused by several things, namely patient delay, doctor or medical personnel's ignorance (doctor delay) and pre-hospital delay (pre-hospital delay). Hospital delay is also a cause of delay in treatment in breast cancer patients, namely the time from the patient's arrival to the point of care until the start of the prescribed medical therapy guidelines. From some of these causes, it can also be grouped the factors that cause cancer delay in the form of predisposing factors, precipitation factors and supporting factors. The purpose of this study was to determine how the factors of delay in breast cancer treatment were treated at the Cut Meutia General Hospital, Aceh Utara. This type of research is descriptive analytic with a retrospective approach. The population in this study were inpatients and outpatients for breast cancer totaling 85 respondents using the Lemeshow formula. The results of the study showed that the value of knowledge was 37 people (43.5%), there was fear as many as 56 people (65.9%), low socioeconomic conditions as many as 40 people (47.1%), affordable health facilities were 64 people (75.3%), had insurance. As many as 77 people (90.6%), had visited alternative medicine as many as 49 people (57.6%) and had family support as many as 65 people (76.5%). The conclusion of this research is the importance of BSE (Breast Self-Examination) education to the public.

Relationship of family function and pre-hospital delay among Chinese patients with recurrent ischaemic stroke and the mediation effect of stigma.

Pre-hospital delay refers to the time span from the onset of symptoms to arrival at a hospital ≥ 3 h and is the main limitation of stroke reperfusion therapies. Family factors and stroke-related stigma may influence pre-hospital delay. However, few studies have confirmed the influence of stigma on pre-hospital delay or explored the relationships between family function, stigma, and pre-hospital delay among patients with recurrent stroke. This study aimed to explore the relationship between family function and pre-hospital delay among patients with recurrent stroke and examine the mediation role of stigma in this relationship. A cross-sectional study was performed at the neurology departments of two hospitals in Guangzhou, China between July 2021 and April 2022. A total of 115 patients with recurrent stroke completed questionnaires and were included in the analysis. Data were collected using the Short Form Family Assessment Device, the Stroke Stigma Scale, and the Stroke Knowledge Questionnaire. Spearman's correlation and a structural equation model were used for data analysis. Family function directly influenced pre-hospital delay [β=0.27, P = 0.033, 95%CI = (0.02-0.51)] and indirectly influenced pre-hospital delay [β=0.17, P = 0.038, 95%CI = (0.02-0.34)] through stigma. Moreover, stigma partially mediated the effect of family function on pre-hospital delay. Family function and stigma directly and indirectly influenced pre-hospital delay among patients with recurrent stroke. Future health education and interventions need to focus on strengthening and improving emotional support from family members to improve family function and reduce stigma, thereby reducing pre-hospital delay among patients with recurrent stroke.

Importance of Acute Coronary Syndrome Knowledge to Improve Early Detection and Reduce Prehospital Delay in Patient with Acute Coronary Syndrome: A Systematic Review

BACKGROUND: Acute coronary syndrome (ACS) is still a global cause of mortality and morbidity. Early detection of ACS is crucial management in preventing the high mortality rate. Several research results show that the perception of the severity of the symptoms is also one of the factors that prompt them to immediately seek help at the hospital. The higher the knowledge of the patient at risk of recognizing the signs and symptoms of ACS, the faster the time required for early detection will trigger a shorter time to seek help. AIM: This study will focus on the effect of knowledge about ACS on early detection and pre-hospital delay. METHODS: A systematic literature search was conducted in the following databases: PubMed, ProQuest, and Science Direct. Keywords used for the search included “knowledge,” “education,” “early detection,” “prehospital delay,” and “acute coronary syndrome” to identify studies published between 2018 and 2022. 709 citations of journal articles written between 2018 and 2020 have been reviewed and 20 studies were meet all of the inclusion criteria. RESULTS: The result shows that knowledge about ACS symptom and the risk factor is important to improve early detection with decreased misinterpretation and misdiagnosis, this condition will lead reduce prehospital delay because increase the need for treatment-seeking as soon as possible. CONCLUSION: Knowledge about ACS symptom and the risk factor is important to improve early detection with decreased misinterpretation and misdiagnosis, this condition will lead reduce prehospital delay because increase the need for treatment-seeking as soon as possible.

Медико-социальная характеристика пациентов с поздней госпитализацией при остром аппендиците

Prehospital delay in acute appendicitis leads to severe consequences – complications, increase in extent of surgical intervention and length of stay. The purpose of this research is to describe and analyze the medical and social characteristics of patients with acute appendicitis at prehospital delay and to create possible solutions in the Tambov Region. Materials and methods. We analyze 33 medical history case reports of patients with acute appendicitis at prehospital delay in the Tambov City Clinical Hospital no. 3 named after I.S. Dolgushin in 2022, the sample was formed by the method of directional selection. Special clinical and statistical study cards were developed and filled in. The results of the copying were entered into an electronic database in the Excel-2010 spreadsheet mode. Statistical data were processed using descriptive statistics methods. Conclusion. The following factors affect the duration of hospitalization for acute appendicitis: incomplete clinical picture, intensity of pain, self-medication, concomitant diseases (for example, diabetes mellitus), distance between the place of residence and a professional hospital, as well as the time of year.

The impact of the coronavirus pandemic on patients hospitalized due to acute coronary syndrome.

The coronavirus disease 2019 (COVID-19) pandemic significantly increased mortality worldwide. However, only part of the excess mortality is related directly to the infection. Local healthcare accessibility, time to reach medical care and patients' reluctance to seek medical aid strongly affected the treatment results in many fields. The current report aims to analyze mortality and morbidity in patients who suffered from acute coronary syndrome (ACS) during the COVID-19 pandemic, as well as to investigate the factors that may have a significant impact on their baseline characteristics and outcome. Multiple reports were evaluated. Most of them point to reluctance and longer time to reach medical care, longer pre-hospital delay, lower overall number of ACS admissions, greater percentage of ST-elevation myocardial infarction patients and complications. Younger and less ill patients were more likely to suffer from ACS than in the pre-pandemic period. They presented with more prominent biomarker elevation. Further, the number of invasive procedures dropped significantly, which was most prominent in the field of surgical revascularization. Consequently, a higher number of adverse events and greater mortality during the COVID-19 pandemic were noted, which was valid for both patients with and without coronavirus infection. In summary, the pandemic had a great impact on overall populational mortality and morbidity, which was greatly pronounced in patients with cardiovascular disease, particularly in ACS cases. They differed in baseline characteristics, underwent different treatment and their outcome was worse as compared with the period prior to the pandemic.

Evaluation of stroke pre-hospital management in Lebanon from symptoms onset to hospital arrival and impact on patients’ status at discharge: a pilot study

BackgroundHospital arrival time after acute ischemic stroke onset is the major factor limiting the eligibility of patients to receive intravenous thrombolysis. Shortening the prehospital delay is crucial to reducing morbidity and mortality for stroke patients. The study was conducted to investigate the factors that influence hospital arrival time after acute stroke onset in the Lebanese population and to assess the effect of the prehospital phase on patients’ prognosis at discharge.MethodA prospective cross-sectional study was performed in eleven hospitals from April to July 2021 including 100 patients having stroke symptoms or transient ischemic attack (TIA). Two questionnaires were used to collect data addressing patient management in the pre-hospital phase and the in-hospital phase. Descriptive and bivariate analyses were done to evaluate the potential associations between prognosis, pre-hospital characteristics, and other factors.ResultsThe patients’ mean age was 70.36 ± 12.25 years, 43 (53.8%) of them were females, and 79 (85%) arrived within 3 hours after symptoms onset. Diabetic patients had a significant delay in hospital arrival compared with non-diabetics (27.0%vs.7.1%, p-value = 0.009). Moreover, 37 (75.5%) of school-level education patients arrived early at the hospital compared to 7 (100%) of university-level education (p-value = 0.009). The modified Rankin Scale (mRS) at discharge in patients with hemorrhagic stroke (10 (90%)) was worse than that in patients with ischemic stroke (38 (80%)) or TIA (3 (15%)) (p-value< 0.001).ConclusionThe study findings make it imperative to raise awareness about stroke symptoms among the Lebanese population. Emergency Medical Services should be utilized appropriately in the transportation of stroke patients to achieve optimal patient outcomes.

Reducing gap in pre-hospital delay between women and men presenting with ST-elevation myocardial infarction.

This study aimed to analyse changes in pre-hospital delay over time in women and men presenting with ST-elevation myocardial infarction (STEMI) in Switzerland. AMIS Plus registry data of patients admitted for STEMI between 2002 and 2019 were analysed using multivariable quantile regression including the following covariates: interaction between sex and admission year, age, diabetes, pain at presentation, myocardial infarction (MI) history, heart failure history, hypertension, and renal disease. Among the 15,350 patients included (74.5% men), the median (interquartile range) delay between 2002 and 2019 was 150 (84; 345) min for men and 180 (100; 414) min for women. The unadjusted median pre-hospital delay significantly decreased over time for both sexes but the decreasing trend was stronger for women. Specifically, the unadjusted sex differences in delay decreased from 60 min in 2002 (P = 0.0042) to 40.5 min in 2019 (P = 0.165). The multivariable model revealed a significant interaction between sex and admission year (P = 0.038) indicating that the decrease in delay was stronger for women (-3.3 min per year) than for men (-1.6 min per year) even after adjustment. The adjusted difference between men and women decreased from 26.93 min in 2002 to -1.97 min for women in 2019. Over two decades, delay between symptom onset and hospital admission in STEMI decreased significantly for men and women. The decline was more pronounced in women, leading to the sex gap disappearing in the adjusted analysis for 2019.

Factors Associated with Prehospital Delay in Patients with Acute Stroke in South India.

Early hospital presentation is critical in the management of acute ischemic stroke. The effectiveness of stroke treatment is highly dependent on the amount of time lapsed between onset of symptoms and treatment. This study was aimed to identify the factors associated with prehospital delay in patients with acute stroke. A cross-sectional descriptive study was conducted in Sri Ramachandra University Hospital, India. A total of 210 patients hospitalized in the stroke unit were included. Patients' data were obtained by interviewing the patient and/or accompanying family member and by reviewing their medical records using a standard questionnaire. Associations were determined between prehospital delay (≥4.5 h) and variables of interest by using univariate and multivariate logistic regression analyses. The prehospital delay was observed in 154 patients (73.3%) and the median prehospital delay was 11.30 h. The following are the factors significantly (P < 0.05) attributed for the delay in presenting to the hospital: contextual factors like using public transport (bus), taxi, time of onset of symptoms, 7 pm-3 am; family history of stroke, perceived cognitive and behavioral factors like, wishing or praying for the symptoms to subside on its own, hesitation to travel due to long distance, delay in arranging transport, and arranging money for admission and wasting time by shopping for general practitioners, nursing homes, and hospitals. The presence of stroke symptom, headache, significantly decreased the prehospital delay. Prehospital delay is high in South India and influenced by clinical, contextual, and cognitive/behavioral factors.

Exploration of pre-hospital patient delays in seeking care for symptoms of bacteremia and sepsis: A qualitative study.

We explored patient pre-hospital delays in seeking care for symptoms of bacteremia and sepsis. A qualitative descriptive study. In January 2021, we recruited a convenience sample of four men and six women who were former patients diagnosed with bacteremia. We conducted semi-structured interviews by telephone. The tape-recorded interviews were transcribed, coded and analysed using the Common-Sense Model of Self-Regulation. Data analysis continued until May 2021. The three main themes included: gathering threads of information, weaving together the threads of information and impact and outcome of the illness. The main finding revealed was that an inability to recognize symptoms of bacteremia resulted in delayed help-seeking. Participants had difficulty recognizing their symptoms as being related to bacteremia when they lacked experience with infection or could not differentiate them from symptoms of other chronic co-morbid conditions. Recognizing symptoms and searching for their meaning was an early step in developing an action plan for seeking care. Patient-reported physical and psychological outcomes of the infection on their quality of life (QOL) varied widely, from none to major impact.

Symptom recognition and treatment-seeking behaviors in women experiencing acute coronary syndrome for the first time: a qualitative study

BackgroundWomen are more likely to delay medical help-seeking for ACS symptoms. Understanding patients’ experience of the symptoms and their response is essential in improving help-seeking behaviors and timely diagnosis and treatment for ACS. This study aimed to explore women’s experience of ACS, their response to the symptoms, and treatment-seeking decisions.MethodsThis qualitative descriptive study was conducted in a tertiary referral specialized heart hospital affiliated with Tabriz University of Medical Sciences, Iran. Participants included 39 women who had experienced ACS for the first time.ResultsFour main themes emerged from the analysis of interview transcripts: (1) the onset of symptoms, (2) the types of symptoms, (3) response to symptoms and (4) arriving at the hospital. These themes and associated sub-themes explained women’s experience of ACS symptoms, their response to the symptoms, and decision to seek medical help.ConclusionsThis study identified and discussed factors contributing to the prehospital delay in women and their decision-making to seek medical care for ACS symptoms. The results are consistent with previous research indicating that ACS symptoms in women are somewhat different from men, and women tend to underestimate their symptoms and attribute them to non-cardiac causes. Women should be supported to develop awareness and understanding of ACS symptoms and appreciate the importance of early treatment-seeking in the disease outcomes.

Impacts of COVID-19 on Patients With Common Surgical Emergencies at the King Fahad Specialist Hospital in Buraidah, Saudi Arabia.

The COVID-19 pandemic is a global disaster with millions of infections and deaths. Healthcare systems and services were significantly affected, necessitating adjustments. These included postponement of scheduled appointments and elective surgeries. During the pandemic, there was an increase in the number of acute appendicitis, gallstones, and hernia with a significant impact on the signs and symptoms of presenting problems due to prehospital delay. This study aims to measure the impacts of COVID-19 on patients with common surgical emergencies in King Fahad Specialist Hospital, Buraidah, Saudi Arabia. This is a single-center retrospective study conducted at King Fahad Specialist Hospital in Buraidah, Saudi Arabia. We reviewed all medical records of patients diagnosed with common surgical emergencies (acute appendicitis, gallstones, and hernia) during a selected time of COVID-19 lockdown and compared it with a similar set period before the crisisas a control sample. All medical records were reviewed to find out the overall number of admissions, frequency of emergency department (ED) visits, duration of illness, picture of clinical presentation, intraoperative findings, course and duration of admission, and final pathology if any. A total of 322 patients were included in the study. Of these, 119 (37%) patients underwent surgery before COVID-19while 203 (63%) patients underwent surgery during the pandemic. The diagnosis of acute appendicitis was 63.9% and 47.7%, hernia 27.7% and 34.6%, and gallstone was 8.4% and 17.7% for control and pandemic periods, respectively. The duration varied from 10 hours to two days and four hours to one month, seven hours to one day to eight hours to six months, and two hours to one day to seven hours to one and half a month for acute appendicitis, hernia, and gallstone in control and pandemic period, respectively. The mean length of stay for acute appendicitis was reduced from two days during the control period to one day during the pandemic period, from four to three days for gallstone, and for hernia, it remained three days for both the control and pandemic periods, respectively. Regarding the course of admission for acute appendicitis, the uneventful cases were reducedwhile an increase in uneventful cases for both hernia and gallstone was observed. During the COVID-19 pandemic, there was a noticeable reduction in hospital visits. We observed an increase in the number of one-time visits and a reduction of three, four, and seven-time visits, which was attributed to the fact that patients have been reported to visit the hospital after a long time from the onset of symptoms with a higher chance of complication and subsequent surgeries. The number of acute appendicitis cases was reduced while the cases of hernia and gallstones increased significantly. The minimum period for the duration of acute illness for appendicitis was reduced in the pandemic period, while the minimum period for both gallstone and hernia was increasedas both conditions could requireconservative management. The mean length of hospital stay was reduced during the pandemic period, mainly due to the early discharge implementedin COVID-19 protocols to decrease the risk of infection. The severity of symptoms was increased due to the cancellation and delaying of surgeries.