Prehospital Delay and Stroke-related Symptoms

Abstract

Objective Prehospital delay is the major cause of treatment delay in stroke. This study was conducted to clarify the contribution of specific stroke-related symptoms to prehospital delay. Methods A consecutive series of 469 patients hospitalized within 2 weeks of stroke onset was collected. In this study, prehospital delay was defined as the time interval from recognition of stroke-related symptoms to hospital arrival. The prevalence of each symptom or sign and prehospital delay were analyzed. Results Weakness of the lower limb (43.5%) was the most common symptom followed by weakness of the upper limb (37.1%) and dysarthria (31.6%). Conversely, the most common sign was weakness of the upper limb (54.1%) followed by dysarthria (53.3%), weakness of the lower limb (53.1%), and sensory disturbance (39.0%). The presence of confusion/decreased level of consciousness (p<0.001), aphasia (p<0.001), headache (p=0.017), and nausea/vomiting (p=0.035) were associated with earlier hospital visitation compared with the absence of these symptoms in univariate analyses. Conversely, the presence of sensory disturbance (p= 0.0017) and vertigo/dizziness (p=0.044) were associated with a significant delay in hospital visitation compared with the absence of these symptoms. There was a discrepancy in the prevalence between symptoms recognized by the patients or bystanders and signs diagnosed by the physicians. Conclusion There was a significant overall correlation between prehospital delay and the National Institute of Health Stroke Scale scores. Public education is therefore necessary to encourage early hospital visitation even with the appearance of mild symptoms.

Pre-hospital delay and its associated factors in first-ever stroke registered in communities from three cities in China

“…Regarding symptoms and/or signs, only patients with coma were found to be less likely to have a prehospital delay compared to patients without. Similar to this study, stroke patients with coma were often transferred to the emergency department or hospital earlier in previous studies 11 15 26 28 33 .…”

Factors associated with prehospital delay in acute stroke: systematic review

“…Therefore, seven papers were read in full (3rd stage), and one article was excluded, which was in disagreement with the inclusion criteria 14 . At the end, the total of six papers was reached.…”

“…Prehospital delay has been considered the major cause of delay in the treatment of stroke 14 . It has been decisive the low level of knowledge about the emergency medical services and the availability of acute stroke treatment in Brazil 15 In view of the explicit importance of this clinical entity, the present study aims to reveal the main obstacles faced by patients suffering from stroke to obtain hospital care.…”

Time to Hospital Admission of Stroke Patients in Department of Neurology Hasan Sadikin General Hospital Bandung

“…4 Waktu adalah hal yang sangat penting dalam penanganan akut stroke. 5 Durasi waktu ketika pasien mengalami gejala sampai dengan kedatangan pasien ke rumah sakit disebut prehospital delay. Prehospital delay menjadi faktor penting dalam menentukan apakah seorang pasien stroke memenuhi syarat untuk diberikan penanganan akut.…”