Understanding delays in acute stroke care: a systematic review of reviews

Lachkhem, Yacine; Rican, Stéphane; Minvielle, Étienne

doi:10.1093/eurpub/cky066

Cited by 36 publications

(30 citation statements)

References 37 publications

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“…An intracranial lesion, e.g., a stroke, is a frequent cause of a decreased level of consciousness [3,4]. and should be recognized as early as possible to avoid a delay in transport to an optimal tertiary-care unit with appropriate recanalization and neurosurgical capabilities [5,6]. Several scoring systems have been developed to recognize ischemic stroke and especially large vessel occlusions [7,8].…”

Section: Introductionmentioning

confidence: 99%

A potential method of identifying stroke and other intracranial lesions in a prehospital setting

Saviluoto

Harve‐Rytsälä

Lääperi³

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Identifying stroke and other intracranial lesions in patients with a decreased level of consciousness may be challenging in prehospital settings. Our objective was to investigate whether the combination of systolic blood pressure, heart rate and age could be used to identify intracranial lesions. Methods: We conducted a retrospective case-control study including patients with a decreased level of consciousness who had their airway secured during prehospital care. Patients with intracranial lesions were identified based on the final diagnoses at the end of hospitalization. We investigated the ability of systolic blood pressure, heart rate and age to identify intracranial lesions and derived a decision instrument. Results: Of 425 patients, 127 had an intracranial lesion. Patients with a lesion were characterized by higher systolic blood pressure, lower heart rate and higher age (P < 0.0001 for all). A systolic blood pressure ≥ 140 mmHg had an odds ratio (OR) of 3.5 (95% confidence interval [CI] 1.7 to 7.0), and > 170 mmHg had an OR of 8.2 (95% CI 4.5-15.32) for an intracranial lesion (reference: < 140 mmHg). A heart rate < 100 beats/min had an OR of 3.4 (95% CI 2.0 to 6.0, reference: ≥100). Age 50-70 had an OR of 4.1 (95% CI 2.0 to 9.0), and > 70 years had an OR of 10.2 (95% CI 4.8 to 23.2), reference: < 50. Logarithms of ORs were rounded to the nearest integer to create a score with 0-2 points for age and blood pressure and 0-1 for heart rate, with an increasing risk for an intracranial lesion with higher scores. The area under the receiver operating characteristics curve for the instrument was 0.810 (95% CI 0.850-0.890). Conclusions: An instrument combining systolic blood pressure, heart rate and age may help identify stroke and other intracranial lesions in patients with a decreased level of consciousness in prehospital settings. Trial registration: Not applicable.

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Section: Introductionmentioning

confidence: 99%

A potential method of identifying stroke and other intracranial lesions in a prehospital setting

Saviluoto

Harve‐Rytsälä

Lääperi³

et al. 2020

Scand J Trauma Resusc Emerg Med

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“…24 In return, the efforts to increase thrombolysis rates within the therapeutic window have been counteracted and diminished. 25 Lachkhem et al 26 defined the timeframe of AIS into four stages, that is, onset recognition to intention to seek medical service; intention to actual medical contract; contact to hospital admission and admission to treatment. The Shenyang ASCaM may have reduced the prehospital delay by raising public awareness of symptom recognition.…”

Section: Discussionmentioning

confidence: 99%

Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months

et al. 2020

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BackgroundThe rate of intravenous thrombolysis for acute ischaemic stroke remains low in China. We investigated whether the implementation of a citywide Acute Stroke Care Map (ASCaM) is associated with an improvement of acute stroke care quality in a Chinese urban area.MethodsThe ASCaM comprises 10 improvement strategies and has been implemented through a network consisting of 20 tertiary hospitals. We identified 7827 patients with ischaemic stroke admitted from April to October 2017, and 506 patients underwent thrombolysis were finally included for analysis.ResultsCompared with ‘pre-ASCaM period’, we observed an increased rate of administration of tissue plasminogen activator within 4.5 hours (65.4% vs 54.5%; adjusted OR, 1.724; 95% CI 1.21 to 2.45; p=0.003) during ‘ASCaM period’. In multivariate analysis models, ‘ASCaM period’ was associated with a significant reduction in onset-to-door time (114.1±55.7 vs 135.7±58.4 min, p=0.0002) and onset-to-needle time (ONT) (169.2±58.1 vs 195.6±59.3 min, p<0.0001). Yet no change was found in door-to-needle time. Clinical outcomes such as symptomatic intracranial haemorrhage, favourable functional outcome (modified Rankin Scale ≤2) and in-hospital mortality remained unchanged.ConclusionThe implementation of ASCaM was significantly associated with increased rates of intravenous thrombolysis and shorter ONT. The ASCaM may, in proof-of-principle, serve as a model to reduce treatment delay and increase thrombolysis rates in Chinese urban areas and possibly other highly populated Asian regions.

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“…One study suggested that the public policy aim of the utilization rate of intravenous thrombolysis should be more than 12% to have a signi cant population effect on disability [7]. Many studies have reported on the effectiveness of rt-PA treatment and global guidelines recommending the use of rt-PA in selected patients [8,9]. However, only a small proportion of patients (1.05-8.6%) receive thrombolysis treatment [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…Pre-hospital delay is an important cause of the inability of patients with ischaemic stroke to obtain thrombolytic therapy at the appropriate time [16]. It has also become an important challenge in the management of stroke care [17]. Delays in medical treatment can be caused by the lack of recognition of stroke symptoms, failure to treat immediately when symptoms occur, transfer from general clinics to hospitals, and failure to use emergency medical services [2,18,19].…”

Section: Introductionmentioning

confidence: 99%

“Hesitating and puzzling”: The experiences and decision process of acute ischaemic stroke patients with prehospital delay after the onset of symptoms

Wang1

Tsao

Lin

et al. 2021

Preprint

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Background Despite campaigns to increase public awareness of stroke symptoms by advocating FAST(Face-Arms-Speech-Time), some stroke patients still show delays in the recognition of and response to stroke symptoms and miss the golden first 4.5 hours to receive rt-PA treatment. The aim of this study was to explore how acute ischaemic stroke patients with prehospital delay seek help and undergo the decision process before arriving at the hospital. Methods A qualitative approach using a grounded theory was applied. There were 24 ischaemic stroke patients recruited by purposive sampling. Results “Hesitating and puzzling” was the core category to describe and guide the process of acute ischaemic stroke patients with prehospital delay. During this process, “Sudden loss of physical limbs sensation and dysfunction” was identified as the antecedent condition. This process would be marked by action and interaction among the following categories: “Self-judgement and self-rationalization”, “Self-treatment and seek medical attention nearby”, “Puzzling and doubting-it may only be a minor problem”, “Worse symptoms” needing immediate advanced medical help and “Rush to nearby ER-self-alerting that serious disease is coming”. Eventually, the patients would be informed that they were admitted to the ER too late to receive rt-PA and would become sad, melancholy and regretful about becoming a disable person. Conclusions The study emphasizes the importance of educating the community residents about identifying stroke symptoms and seeking medical attention immediately. These results will assist the healthcare providers by offering references for designing patient-centric educational strategies for preventing stroke pre-hospital delay to improve the quality of stroke medical care.

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Understanding delays in acute stroke care: a systematic review of reviews

Cited by 36 publications

References 37 publications

A potential method of identifying stroke and other intracranial lesions in a prehospital setting

A potential method of identifying stroke and other intracranial lesions in a prehospital setting

Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months

“Hesitating and puzzling”: The experiences and decision process of acute ischaemic stroke patients with prehospital delay after the onset of symptoms

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