Factors Associated with Delay of Emergency Medical Services Activation in Patients with Acute Stroke

Seo, Ah Ram; Song, Hyun; Lee, Woon Jeong; Park, Kyu Nam; Jundong, Moon; Kim, Dae–Hee

doi:10.1016/j.jstrokecerebrovasdis.2020.105426

Cited by 7 publications

(6 citation statements)

References 18 publications

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“…We identified 67 studies addressing pre-hospital organizational factors associated with delay or access to ART ( Appendix A - Table A3 ). Activation of stroke code, pre-hospital notification and use of pre-hospital emergency services [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], mobile stroke units [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], implementation of specific electronic apps to insert and share clinical data with the hospital stuff [ 33 ], use of ambulance [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ], telestroke [ 47 , 48 ], implementation of specific pre-hospital protocols [ 49 , 50 ], education campaigns […”

Section: Resultsmentioning

confidence: 99%

“…Under-recognition or delays in recognition of stroke symptoms are consistently identified as one of the main causes of pre-hospital delays [ 8 , 16 ]. Hence, with no surprise, population campaigns focused on stroke recognition, severity and existence of treatment emerged as a common factor to promote ART [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 20 , 23 , 34 , 36 , 38 , 39 , 40 , 41 , 46 , 48 , 103 , 104 , 105 , 106 , 107 , 108 ]. Sustainable levels of population awareness may only be achieved by continuous education campaigns, probably at least six months each [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

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Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

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et al. 2022

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Background: After onset of acute ischemic stroke (AIS), there is a limited time window for delivering acute reperfusion therapies (ART) aiming to restore normal brain circulation. Despite its unequivocal benefits, the proportion of AIS patients receiving both types of ART, thrombolysis and thrombectomy, remains very low. The organization of a stroke care pathway is one of the main factors that determine timely access to ART. The knowledge on organizational factors influencing access to ART is sparce. Hence, we sought to systematize the existing data on the type and frequency of pre-hospital and in-hospital organizational factors that determine timely access to ART in patients with AIS. Methodology: Literature review on the frequency and type of organizational factors that determine access to ART after AIS. Pubmed and Scopus databases were the primary source of data. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale. Results: A total of 128 studies were included. The main pre-hospital factors associated with delay or access to ART were medical emergency activation practices, pre-notification routines, ambulance use and existence of local/regional-specific strategies to mitigate the impact of geographic distance between patient locations and Stroke Unit (SU). The most common intra-hospital factors studied were specific location of SU and brain imaging room within the hospital, and the existence and promotion of specific stroke treatment protocols. Most frequent factors associated with increased access ART were periodic public education, promotion of hospital pre-notification and specific pre- and intra-hospital stroke pathways. In specific urban areas, mobile stroke units were found to be valid options to increase timely access to ART. Conclusions: Implementation of different organizational factors and strategies can reduce time delays and increase the number of AIS patients receiving ART, with most of them being replicable in any context, and some in only very specific contexts.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Botelho

Rios

Fidalgo

et al. 2022

IJERPH

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“… 17 In addition, stroke patients who visited their family doctors instead of making EMS calls had approximately four times the odds, and situations in which it was difficult to recognize stroke symptoms, such as in cases of a patient with an alert mental state, had about three times the odds. 18 19 …”

Section: Discussionmentioning

confidence: 99%

Pre-Hospital Delay in Patients With Acute Stroke During the Initial Phase of the Coronavirus Disease 2019 Outbreak

et al. 2022

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Background When a sudden outbreak of an infectious disease occurs, emergency medical services (EMS) response could be negatively affected. The poor prognosis of acute stroke may be largely attributed to delays in treatment. This study aimed to identify the impact of the sudden outbreak of coronavirus disease 2019 (COVID-19) on EMS response for patients with acute stroke. Methods This comparative cross-sectional study was conducted in 25 safety centers in Seoul, Korea. We enrolled patients with acute stroke who were transferred to the emergency department by EMS. The study period was from February–April 2020 and the same period in 2019. Patients were divided into two groups, pre-COVID-19 period and early-COVID-19 period, and previously collected patient data were analyzed. We performed comparative analyses of EMS response and clinical outcomes between the groups. Results Of 465 patients, 231 (49.7%) had an acute stroke during the study period. There was no significant difference between clinical characteristics of patients with acute stroke before and after the COVID-19 outbreak. EMS response times increased significantly during the early COVID-19 outbreak. The intensive care unit admission rate and mortality rate increased during the early COVID-19 outbreak. Conclusion In the initial phase after the sudden COVID-19 outbreak, EMS response times for acute stroke were delayed and the clinical outcomes of patients with acute stroke deteriorated.

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“…Further study is warranted to elucidate associations between changes in clinical characteristics including the ODT and outcomes in patients with TIA/mild stroke. Third, ABCD 2 score and some clinical information that might be associated with seeking medical attention [e.g., bystanders, cognitive impairment, initial perception of symptoms, socioeconomic status, or area/infrastructure at residence ( 36 , 37 )] were not included in the analysis. Finally, changes in clinical characteristics during the COVID-19 epidemic in patients with pre-stroke disability or in-hospital stroke were not investigated.…”

Section: Discussionmentioning

confidence: 99%

Delays in Presentation Time Under the COVID-19 Epidemic in Patients With Transient Ischemic Attack and Mild Stroke: A Retrospective Study of Three Hospitals in a Japanese Prefecture

et al. 2021

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Background: Coronavirus Disease 2019 (COVID-19) has spread worldwide with collateral damage and therefore might affect the behavior of stroke patients with mild symptoms seeking medical attention.Methods: Patients with ischemic stroke who were admitted to hospitals within 7 days of onset were retrospectively registered. The clinical characteristics, including onset-to-door time (ODT), of patients with a transient ischemic attack (TIA)/mild stroke (National Institutes of Health Stroke Scale [NIHSS] score of ≤ 3 on admission) or moderate/severe stroke were compared between those admitted from April 2019 to March 2020 (pre-COVID-19 period) and from April to September 2020 (COVID-19 period). Multivariable regression analysis was performed to identify factors associated with the ODT.Results: Of 1,100 patients (732 men, median age, 73 years), 754 were admitted during the pre-COVID-19 period, and 346 were admitted during the COVID-19 period. The number and proportion of patients with TIA/minor stroke were 464 (61.5%) in the pre-COVID-19 period and 216 (62.4%) during the COVID-19 period. Among patients with TIA/mild stroke, the ODT was longer in patients admitted during the COVID-19 period compared with that of the pre-COVID-19 period (median 864 min vs. 508 min, p = 0.003). Multivariable analysis revealed the COVID-19 period of admission was associated with longer ODT (standardized partial regression coefficient 0.09, p = 0.003) after adjustment for age, sex, route of arrival, NIHSS score on admission, and the presence of hypertension, diabetes mellitus, and wake-up stroke. No significant change in the ODT was seen in patients with moderate/severe stroke.Conclusions: The COVID-19 epidemic might increase the ODT of patients with TIA/mild stroke.

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Factors Associated with Delay of Emergency Medical Services Activation in Patients with Acute Stroke

Cited by 7 publications

References 18 publications

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Pre-Hospital Delay in Patients With Acute Stroke During the Initial Phase of the Coronavirus Disease 2019 Outbreak

Delays in Presentation Time Under the COVID-19 Epidemic in Patients With Transient Ischemic Attack and Mild Stroke: A Retrospective Study of Three Hospitals in a Japanese Prefecture

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