Stroke Patients In Taiwan Research Articles

Prehospital delay and emergency department management of ischemic stroke patients in taiwan, r.o.c.

Objective. To determine the magnitude of prehospital delay and how much time elapses between emergency department (ED) presentation and ED clinical investigations in ischemic stroke patients. Factors associated with prehospital delay were also correlated with demographic characteristics and clinical variables. Methods. A prospective, observational study was conducted simultaneously in five community teaching hospitals in Taiwan from October 1997 to April 1998. Included were all patients presenting with acute ischemic stroke. In each case, diagnosis was confirmed by cranial CT scanning. The main outcomes measured were the number of patients presenting at the ED more than two hours after the onset of symptoms (Tprehospital > 2 hr) and the time spent at the ED for ED physician evaluation, cranial CT scanning, laboratory examinations, and neurologic consultation. Chi-square testing was used to compare the characteristics of patients with Tprehospital > 2 hr. and those with Tprehospital ≤ 2 hr. Independent predictors of Tprehospital > 2 hr were determined using multiple logistic regression. Results. Of 157 patients observed, 105 (67%) arrived at the hospital more than 2 hr after the onset of symptoms. Average time from ED presentation to examination by ED physician, completion of CT scanning, and laboratory investigations was 3, 58, and 61 minutes, respectively. Mean time from ED presentation to neurologic consultation was 174 minutes for 38 patients [24%, (38/157)1. The factor associated with Tprehospital > 2 hr was interhospital transfer (p < 0.05). Conclusion. This study reveals that delayed management of stroke patients is mainly due to delayed ED presentation and to difficulties in obtaining neurologic consultation. Ideally, a stroke center may be incorporated within the EMS system to overcome delays due to interhospital transfer and to difficulties in obtaining neurologic consultation.

Burden among Caregivers of Stroke Patients in Taiwan

Burden among Caregivers of Stroke Patients in Taiwan

Evident risk factors for younger stroke patients in Taiwan

Risk factors for stroke in the young are often different from those in older patients. Since a rather high incidence of stroke exists in Taiwan, we prospectively studied risk factors in 208 stroke patients aged between 15 and 45 years seen in four main hospitals in Taiwan from 1986 to 1993. Of the 116 patients with cerebral infarction, 48 (41.4%) had related premature atherosclerosis mainly caused by hypertension (18.1%), hyperlipidemia (4.3%), and diabetes mellitus (3.4%). Thirty-four patients (29.3%) had an identifiable predisposing factor of cardiac origin including valvular diseases. In 92 patients with cerebral hemorrhage, hypertension was present in 30 patients (32.6%) and a vascular malformation of brain in 21 patients (22.8%). For a specific district in Taiwan, the major risk factors for strokes in younger patients were hypertension, rheumatic heart disease, and vascular malformation of brain. Cardiac and neuroradiologic investigations are particularly indicative, and clinical effort in the management of these treatable causes needs emphasis.