Pre-Hospital Delay in Acute Ischemic Stroke Care: Current Findings and Future Perspectives in a Tertiary Stroke Center from Romania—A Cross-Sectional Study

Abstract

Background and objectives: The time interval between stroke onset and hospital arrival is a major barrier for reperfusion therapies in acute ischemic stroke and usually accounts for most of the onset-to-treatment delay. The present study aimed to analyze the pre-hospital delays for patients with acute ischemic stroke admitted to a tertiary stroke center in Romania and to identify the factors associated with a late hospital arrival. Material and methods: The study population consisted of 770 patients hospitalized with the diagnosis of acute ischemic stroke in the University Emergency Hospital Bucharest during a 6-month period, between 1 January and 30 June 2018. Data regarding pre-hospital delays were prospectively collected and analyzed together with the demographic and clinical characteristics of the patients. Results: In total, 31.6% of patients arrived at the hospital within 4.5 h from stroke onset and 4.4% in time intervals between 4.5 and 6 h from the onset, and 28.7% of the patients reached the hospital more than 24 h after onset of symptoms. Transport to hospital by own means was the only factor positively associated with arrival to hospital > 4.5 h from stroke onset and more than doubled the odds of late arrival. Factors negatively associated with hospital arrival > 4.5 h after stroke onset were prior diagnosis of atrial fibrillation, initial National Institute of Health Stroke Scale (NIHSS) score ≥ 16 points, presence of hemianopsia, facial palsy and sensory disturbance. Factors increasing the odds of hospital arrival after 24 h from stroke onset were living alone and living in rural areas. Conclusions: Almost one in three ischemic stroke patients presenting to our center reaches hospital more than 24 h after onset of symptoms. These findings highlight the need for urgent measures to improve not only stroke awareness but also pre-hospital protocols in order to provide timely and appropriate care for our stroke patients.

Stroke signs knowledge and factors delaying acute stroke patients’ hospital arrival in the absence of stroke care systems. A Kinshasa multicenter cross-sectional study

“…To promote the earliest possible access to treatment, the evaluation of intervals between stroke onset and hospital arrival has been the subject of numerous studies (17,27,48,(63)(64)(65)] to determine the most appropriate interventions. They have produced divergent results, re ecting the methodological differences, cultural and educational differences of the populations studied, and differences in the health service organization in general and the stroke chain in particular.…”

Knowledge about Stroke among Workers in Public and Private Enterprises in Brazzaville and Their Attitudes towards Stroke Victims

“…Workers' attitudes towards stroke victims are overall good in our series (score = 81.4%). However, the responses in relation to the item "behavior towards a person with stroke warning signs/symptoms" suggest that, during awareness campaigns, it is important to focus on the time of admission to hospital for stroke victims and its impact on brain cell life, treatment seeking, patient recovery and complications leading to sequelae and death [71] [72] [73] [74] [75]. The normal attitude of workers towards stroke victims could be explained by education and prior information about stroke.…”

Prehospital delay after acute ischemic stroke among Thai older adults: A cross‐sectional study

“…Additionally, bystanders also play a critical role in shortening delay time after the onset of stroke, as they usually take action and call for help. Studies have found that presence of bystander was related to shorter delay among stroke patients (Terecoasă et al, 2022). Among demographic variables, several studies have explored the association between prehospital delay and age (Nagao et al, 2020; Wang et al, 2021), gender (Potisopha et al, 2020), education (Fladt et al, 2019; Nepal et al, 2019), and income (Niklasson et al, 2019; Wang et al, 2021); however, inconsistent and weak associations were reported among those demographic variables.…”

“…Among clinical factors, studies have frequently reported an association between increased stroke severity diagnosis or the degree of neurologic deficit and shorter prehospital delay (Wannarong et al, 2019). Some health conditions associated with early arrival were related to specific risk factors (atrial fibrillation and hypertension), stroke subtype, and stroke history (Terecoas a et al, 2022). Among individual factors, knowledge of stroke has been frequently documented in the literature.…”

“…Distance to hospital is also a key determinant of arrival time (Rakchue & Poonphol, 2019). Usually, patients living near healthcare facilities are more likely to arrive in a timely manner to hospital (Terecoas a et al, 2022).…”