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

Abstract

Background Hospital 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. Method A 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. Results The 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). Conclusion The 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.

Therapeutic journey of patients affected by stroke: cohort study

“…16 Nonetheless, it was different in international studies, such as one held in Indonesia, where the median was 45 minutes, 29 and in another developed in Lebanon, where 32.9% underwent a CT scan in less than 20 minutes. 14 The time spent between the CT scan and the detection of ischemic stroke in the hinterland region was five times longer than in the capital city. In cases of HS, the hinterland took 1.4 times longer than the capital.…”

“…28 On the other hand, a prospective crosssectional survey carried out in Lebanon showed that only 17.7% arrived late, taking more than 3 hours to the health care unit. 14 The discussions regarding time are delicate, because it was evident that investigation designs, materials and methods bring different interpretations for many of the comparisons shown, so that, when investigating time, it is perceived that the cutoff value used to exclude time data pre-hospital care of patients who arrive at the hospital with prolonged delays are different. With respect to the detection time (∆T Detection), it is worth highlighting that this referred to the time spent in the hospital environment.…”

“…28 On the other hand, a prospective cross-sectional survey carried out in Lebanon showed that only 17.7% arrived late, taking more than 3 hours to the health care unit. 14…”

“…16 Nonetheless, it was different in international studies, such as one held in Indonesia, where the median was 45 minutes, 29 and in another developed in Lebanon, where 32.9% underwent a CT scan in less than 20 minutes. 14…”

Current trends and future perspectives of stroke management through integrating health care team and nanodrug delivery strategy

“…Additionally, the strategies used for the pre-hospital transport, networked stroke care, and real-time feedback systems are vital to be considered by the healthcare team ( Lossius and Lund, 2012 ; Kobayashi et al, 2018 ). The early recognition could be attained through various symptoms, including sudden weakness or numbness in the face, arm, or leg on one body side, immediate confusion, trouble speaking, difficult speech, trouble seeing in one or both eyes, dizziness, loss of balance or coordination, severe headache with no known cause ( Kamal et al, 2022 ; Ospel et al, 2022 ).…”