An Analysis of the Admission Delay of Acute Strokes

Ferro, José M.; Melo, Teresa Pinho e; Oliveira, Vítor; Crespo, Manuela; Canhão, Patrı́cia; Pinto, Amélia Nogueira

doi:10.1159/000108455

Cited by 80 publications

(81 citation statements)

References 6 publications

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“…Other studies have chosen the same definition of stroke onset for patients whose symptoms were detected on awakening. 5,6,10 The time of admission was defined as the time the patient presented to the stroke unit in all cases. The exact time of arrival at the stroke unit is routinely marked on the forms of the stroke unit.…”

Section: Methodsmentioning

confidence: 99%

“…4 The most common reason for exclusion from this stroke treatment protocol or other urgent therapeutic protocols is delay in presentation. [5][6][7][8][9][10][11][12] Since the time from stroke onset to hospital arrival is critical in acute stroke management, we sought to determine the factors influencing early admission of acute stroke patients in a French stroke unit.…”

mentioning

confidence: 99%

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Factors Influencing Early Admission in a French Stroke Unit

Derex

Adeleine

Nighoghossian

et al. 2002

Stroke

172

151

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Background and Purpose-Intravenous tissue plasminogen activator improves outcome after ischemic stroke when given within 3 hours of symptoms onset in carefully selected patients. However, only a small proportion of acute stroke patients are currently eligible for thrombolysis, mainly because of excessive delay to hospital presentation. We sought to determine the factors associated with early admission in a French stroke unit. Methods-We prospectively studied the admission delay of acute stroke patients in a French stroke unit during a 12-month period ending July 1999. Univariate and multivariate regression analyses were performed to evaluate the factors influencing early stroke unit admission and transport by the Emergency Medical Services (EMS) or Fire Department (FD) ambulances. Results-One hundred sixty-six patients were primarily admitted to the stroke unit, with a median admission time of 4 hours 5 minutes. Twenty-nine percent presented within 3 hours of symptoms onset and 75% within 6 hours. Univariate analysis showed that early stroke unit arrival was significantly associated with the following factors: female sex, stroke severity assessed by the National Institutes of Health Stroke Scale score, lowered consciousness, sudden onset of stroke, not living alone, recognition of symptoms by bystanders, and transport by EMS or FD ambulances. Age, ethnicity, level of education, employment status, nocturnal onset, distance from place of stroke to the stroke unit, stroke lesion location, presence of brain hemorrhage, and awareness about the symptoms and risk factors of stroke had no measurable effect on early admission. A multivariate regression model demonstrated that the most significant factors associated with early stroke unit arrival were transport by EMS or FD ambulances and sudden onset of stroke. Female sex and not living alone were also significantly associated with early admission in the multivariate model. Multivariate analysis of the mode of transport showed that transport by EMS or FD ambulances was significantly more frequent among female patients, when stroke symptoms were recognized by bystanders, and when the general practitioner was not the first medical contact. Conclusions-The present study shows that hospital arrival within the first hours of stroke is feasible in a French stroke unit. As many as 75% of the patients are admitted within the first 6 hours of stroke. This is the first study demonstrating that stroke unit admission in France is fastest in patients brought to the hospital by EMS or FD ambulances. However, only 35% of stroke patients activate the emergency telephone system and are currently transported by EMS or FD ambulances. French stroke patients should be encouraged to seek immediate medical attention by using the emergency telephone system, and stroke management should be reprioritized in the French EMS as a time-dependent medical emergency, with the same level of organization and expertise currently applied to myocardial infarction. (Stroke. 2002; 33:153-159.)

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Factors Influencing Early Admission in a French Stroke Unit

Derex

Adeleine

Nighoghossian

et al. 2002

Stroke

172

151

View full text Add to dashboard Cite

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“…Revela o baixo nível de conhecimento populacional a respeito do AVC, resultando em demora por busca de atendimento médico 28,29,30 . Os principais motivos identificados pelos estudos são: paciente ou familiar não reconheceu sintomas 30,31,32,33,34,35 , ou não buscou por ajuda 28,36,37 e paciente ou familiar não acionou o serviço pré-hospitalar 20,28,31,36,38 . Entre esses, houve maior frequência de pacientes que moravam sozinhos ou não tinham um acompanhante no momento do início dos sintomas 39 , falta de senso de urgência pelo paciente ou familiar e recusa do paciente em ir para o hospital 31 .…”

Section: Barreiras Externas • Fatores Relacionados Aos Pacientesunclassified

Análise das barreiras à utilização de trombolíticos em casos de acidente vascular cerebral isquêmico em um hospital privado do Rio de Janeiro, Brasil

et al. 2013

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O acidente vascular cerebral isquêmico (AVCi) é uma importante causa de sequela e morte. A correta utilização do trombolítico enfrenta várias barreiras. O objetivo foi discutir as barreiras à terapia trombolítica em pacientes que chegam, com sintomas de AVCi agudo, à emergência de um hospital privado do Rio de Janeiro, Brasil. Coorte retrospectiva de pacientes entre 2009 e 2011. Foram admitidos 257 pacientes com suspeita de AVCi. Dos pacientes com diagnóstico confirmado (156), 11,5% (18) foram trombolisados. Dos 30 pacientes com diagnóstico de AVCi, dentro da janela terapêutica e com NIHSS na faixa para trombólise, 20 não foram trombolisados, 9 por barreiras administrativas (45%). Neste trabalho o percentual de trombólise foi superior ao observado nos Estados Unidos, mas barreiras impediram o tratamento de 45% dos pacientes com indicação à trombólise. Imagina-se que na rede pública brasileira a situação seja ainda mais desfavorável.

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“…Ferro ve ark. (37) yaptıkları çalışmayla tedavi gecikmesinin nedeninin %82 oranında hastane dışından kaynaklandığını göstermişlerdir. Yine aynı şekilde Keskin ve ark.…”

Section: Materyal Metodunclassified

Acil Servise Başvuran Akut İskemik İnmeli 124 Hastanın Geriye Yönelik Bir Yıllık İncelenmesi

Kıyan¹,

Ozsarac²,

Ersel³

et al. 2009

jaem

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AIM:We aimed to intend to contribute to our countries database for acute stroke patients with identifying etiological, epidemiological, demographic and clinical features of those patients. METHODS:This is a retrospective descriptive study. Patients' charts are identified with help of ICD-10 coding system. 124 patients were enrolled to the study. RESULTS:Patients in male gender were 56.5 % (n: 70) and mean age of the study group was 67.5 ± 11.8. Average time of the onset of the symptoms was found to be 13.0 ± 18.5 hours. Only twenty five patients (20.5 %) were attended to the emergency department (ED) with in the there hours of symptoms onset.In patients past medical history, 58.8 % (n: 73) patients are hypertensive, 35.0 % (n: 43) are diabetic, 25.0 % (n: 31) of them have coronary artery disease, 20.1 % (n: 25) have a previously known stroke attack.Hundred patients (80.6 %) have a normal head CT. Mortality and morbidity rate was found to be 0.8 % and 6.5 % respectively in patients who were observed in the ED. Average observation time in the ED was 21.5 ± 30.5 hours (1-168). Fifty one patients (41.1 %) were admitted to intensive care unit and six patients were admitted to the neurology ward. CONCLUSION:Acute ischemic stroke is common in old male patients. Most important risk factors are hypertension and diabetes. Patients mostly attend to the hospitals lately. Observation periods of those patients are very long in the ED.

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An Analysis of the Admission Delay of Acute Strokes

Cited by 80 publications

References 6 publications

Factors Influencing Early Admission in a French Stroke Unit

Factors Influencing Early Admission in a French Stroke Unit

Análise das barreiras à utilização de trombolíticos em casos de acidente vascular cerebral isquêmico em um hospital privado do Rio de Janeiro, Brasil

Acil Servise Başvuran Akut İskemik İnmeli 124 Hastanın Geriye Yönelik Bir Yıllık İncelenmesi

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