If Time Is Brain Where Is the Improvement in Prehospital Time after Stroke?

Abstract

Despite the availability of thrombolytic and endovascular therapy for acute ischemic stroke, many patients are ineligible due to delayed hospital arrival. The identification of factors related to either early or delayed hospital arrival may reveal potential targets of intervention to reduce prehospital delay and improve access to time-critical thrombolysis and clot retrieval therapy. Here, we have reviewed studies reporting on factors associated with either early or delayed hospital arrival after stroke, together with an analysis of stroke onset to hospital arrival times. Much effort in the stroke treatment community has been devoted to reducing door-to-needle times with encouraging improvements. However, this review has revealed that the median onset-to-door times and the percentage of stroke patients arriving before the logistically critical 3 h have shown little improvement in the past two decades. Major factors affecting prehospital time were related to emergency medical pathways, stroke symptomatology, patient and bystander behavior, patient health characteristics, and stroke treatment awareness. Interventions addressing these factors may prove effective in reducing prehospital delay, allowing prompt diagnosis, which in turn may increase the rates and/or efficacy of acute treatments such as thrombolysis and clot retrieval therapy and thereby improve stroke outcomes.

The rate of early neurological deterioration occurring after thrombolytic therapy: A meta‐analysis

“…Therefore, OTT might significantly affect the rate of END occurring after thrombolytic therapy, and the rate might increase with the increase of OTT. Pulvers and Watson () reported that emergency medical pathways, stroke symptomatology, patient and bystander behavior, patient health characteristics, and stroke treatment awareness might affect OTT, and reducing OTT might improve the stroke outcomes, which is consistent with our results.…”

“…Therefore, OTT might significantly affect the rate of END occurring after thrombolytic therapy, and the rate might increase with the increase of OTT. Pulvers and Watson (2017) reported that emergency medical pathways, stroke symptomatology, patient and bystander behavior, patient health characteristics, and stroke TA B L E 3 The results of subgroup analysis F I G U R E 3 Sensitivity analysis of the rate of early neurological deterioration occurring after thrombolytic therapy our results in this meta-analysis did not conform to these conclusions. In the present subgroup analysis by NIHSS at admission, the rate of END occurring after thrombolytic therapy of the patients with NIHSS at admission ≤4.0 was highest among the three groups, which is inconsistent with most literatures.…”

Tiempos de llegada de pacientes con ataque cerebrovascular en un hospital regional de alta complejidad

“…En nuestro trabajo concluimos que llegar por propios medios se asoció a un menor tiempo de llegada, comparado con acceder al hospital en ambulancia, lo que es discordante con varias publicaciones 5,6,18 . Esto pudiera explicarse por el déficit de ambulancias en el sistema público chileno, comparado con países desarrollados.…”

Factores asociados a llegada y evaluación precoz de pacientes con ataque cerebrovascular en un hospital regional de alta complejidad

“…Dentro de los factores más frecuentemente asociados con una llegada precoz al SU de pacientes con ACV agudo destacan: llegada en ambulancia, severidad del ACV, sintomatología, subtipo de ACV, comorbilidades, comportamiento o percepción del paciente y/o familiar al inicio del cuadro y horario de inicio de los síntomas 20 . De los factores asociados a retraso en la llegada de los pacientes destacan: sexo, raza, medio de llegada e historia de enfermedad cardiovascular 21 .…”