Factors Influencing Early Admission in a French Stroke Unit

Abstract

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.)

Decision-tree Model of Treatment-seeking Behaviors after Detecting Symptoms by Korean Stroke Patients

“…This study showed that arriving at hospital was delayed for elderly people living alone and patients without access to outside help at the onset of symptoms. These findings are similar to previous results: that recognition of symptoms by bystanders facilitated an early arrival at hospital (Derex et al, 2002;Rosamond et al, 1998); and elderly people living alone, patients without access to outside help, and patients who do not maintain contact with others experience a delayed arrival at hospital (Wester et al, 1999). Hence, the difficulties experienced by many stroke patients in taking quick and appropriate action by themselves makes it necessary to comprehensively educate families, friends, neighbors, and community as well as the patients themselves.…”

“…A sudden onset of stroke, rapidly progressing symptoms, and continuous symptoms resulted in a higher seriousness of symptoms. These findings are similar to those other studies: a higher NIHSS (National Institutes of Health Stroke Scale Score) (Derex et al, 2002;Chang et al, 2004;Bohannon, Silverman, & Ahlquist, 2003) and more severe neurological symptoms when arriving at hospital (Wester et al, 1999;Goldstein, Edwards, & Wood, 2001;Wang et al, 2002) facilitated an earlier arrival at hospital.…”

“…In many other studies, consciousness disturbance had the greatest effect on an early hospital visit (Derex, Adeleine, Nighoghossian, Honnorat, & Trouillas, 2002;Cho, 1996).…”

Microcatheter to Recanalization (Procedure Time) Predicts Outcomes in Endovascular Treatment in Patients with Acute Ischemic Stroke: When Do We Stop?

“…The American College of Cardiology and the American Heart Association guidelines for the management of ST-elevation myocardial infarction state that percutaneous coronary intervention should be performed as quickly as possible, preferably within 90 minutes from the moment of first medical contact. 18 Although there are similarities between stroke and myocardial infarction treatment, procedure times in stroke have much larger variations due to considerable variability in tortuosity, vessel location, and the nature of the occlusion. 14,16 Such variability in procedure time in patients with acute stroke, unlike those with myocardial infarction, increases the likelihood of a prominent relationship to outcomes.…”

The “Vertical Response Time”: Barriers to Ambulance Response in an Urban Area

“…Because the majority of acute serious medical emergencies take place in residential locations, any additional time it takes to reach patients is particularly important in locales with a high concentration of apartment buildings. [2][3][4][5] Several other studies have reported on-scene to patient time intervals. [6][7][8][9] In a study of four EMS regions in Arizona, the on-scene to patient interval was 1.0 minute.…”