Variables Associated With Hospital Arrival Time After Stroke

Azzimondi, G; Bassein, Leona; Fiorani, L; Nonino, Francesco; Montaguti, Ubaldo; Celin, Daniela; Re, Giuseppe; D’Alessandro, Roberto

doi:10.1161/01.str.28.3.537

Cited by 92 publications

(25 citation statements)

References 20 publications

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“…Nevertheless, efficacy of reperfusion therapy decreases with time. In the literature, only about 30% of acute stroke patients are seen at the ED within 2 h of stroke onset (42% in the present study) [3, 13, 32, 34]. Door-to-needle time was 33 min less in the P1 group than in the P0 group, but the difference was not significant.…”

Section: Discussioncontrasting

confidence: 64%

“…In other series from various countries and different organizations of the health care systems, the percentage of patients arriving within 3 h ranged between 24 and 59% [8,9,10,11,12,13,14,15,16,27,28,29]. …”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that between 24 and 59% of patients present to the hospital within 3 h [8,9,10,11,12,13,14,15,16], but intrahospital delays occur in the diagnosis and treatment of these patients. For successful interventional therapy, there is therefore the need for physician training in rapid diagnostic evaluation and improvements in the organization of the health system.…”

Section: Introductionmentioning

confidence: 99%

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Benefits of a Prehospital Stroke Code System

Belvís

Cocho²,

Martí‐Fàbregas³

et al. 2005

Cerebrovasc Dis

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Background and Objectives: Hospital admission delay is a main limiting factor for effective thrombolytic therapy in stroke patients. We developed a stroke code system for rapid request of emergency transportation to the hospital and a priority availability of the attending neurologist on the patient’s arrival at the Emergency Department (ED). Methods: Over a 1-year period, a 24-hour telephone hotline between the attending neurologist and the Barcelona public emergency coordination service was established. Priority 1 (P1) was defined as a patient with symptoms suggestive of acute stroke with onset of less than 3 h, in which case immediate transportation service and rapid ED reception was organized. Data from patients in the P1 group (n = 39) and patients without activation of the stroke code (P0) (n = 181) were compared. Results: There were significant differences between P1 and P0 groups in mean time from ED arrival to request for neurologic assessment (4.4 ± 19.5 vs. 194.7 ± 244.9 min, p < 0.001), from arrival to neurologic examination (12.6 ± 21.1 vs. 225.3 ± 258.2 min, p < 0.005), and from arrival to performance of brain CT scan (35.5 ± 34.9 vs.120.3 ± 143.2 min, p < 0.001), and also in the number of patients treated with thrombolytic agents (19 vs. 4.5%, p < 0.003). There were no differences between groups in the time elapsed from stroke onset to ED arrival. Conclusions: Activation of the stroke code was effective in increasing the percentage of patients treated with thrombolytic drugs and also in shortening the delay from ED arrival until neurologic assessment and from ED arrival until brain CT.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Benefits of a Prehospital Stroke Code System

Belvís

Cocho²,

Martí‐Fàbregas³

et al. 2005

Cerebrovasc Dis

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“…This indicates the relevance of immediate treatment in ICH patients and leads the focus to younger patients with low comorbidity. In addition to these findings, we here show that the clinically worse patients might represent the majority of admitted patients in the hyperacute stages of the disease [12, 13]. As the initial GCS score is strongly associated with a poor outcome [1, 2], patients of the NOVO7 and FAST trials might reflect a collective with a priori assigned favorable prognosis because of their relatively high median GCS score (i.e.…”

Section: Discussionmentioning

confidence: 61%

“…While the biological signal could be confirmed, the pivotal phase III trial did not have any impact on outcome [11]. There have only been few studies – with focus on ischemic stroke rather than on ICH – investigating possible associations between time window from symptom onset until hospital admission and severity of clinical presentation [12,13,14]. In this study we analyzed whether demographic, clinical and neuroradiological parameters are associated with time to admission in patients with ICH.…”

Section: Introductionmentioning

confidence: 99%

Clinical Severity Predicts Time to Hospital Admission in Patients with Spontaneous Intracerebral Hemorrhage

et al. 2008

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Background: In this study we analyzed whether demographic, clinical and neuroradiological parameters are associated with time to hospital admission in patients with spontaneous intracerebral hemorrhage (ICH). We a priori hypothesized that the earlier a patient was admitted to hospital, the worse the clinical status would be. Methods: Demographic, clinical and neuroradiological parameters of consecutive patients with spontaneous ICH directly admitted to 2 neurological university departments were subjected to correlation, trichotomization and logistic regression analyses for prediction of (i) early hospital admission, and (ii) favorable clinical presentation at admission [dichotomized Glasgow Coma Scale (GCS) score ≧9]. Results: We analyzed 157 patients with a median age of 66 (39–93) years. Patient trichotomization according to the GCS revealed a significant difference (p < 0.001) between all groups with regard to the time from symptom onset to hospital admission: patients with a GCS score of 3–5 were admitted after 105 (40–300) min (mean: 113 ± 53), those with a GCS score of 6–9 after 180 (45–420) min (mean: 184 ± 95) and those with a GCS score of 10–15 after 300 (60–1,560) min (mean: 324 ± 367). There were significant correlations between (i) hematoma volume and GCS (r = –0.632; p < 0.001); (ii) time to admission and GCS (r = 0.596; p < 0.001), and (iii) Graeb scores for intraventricular hemorrhage and hematoma volume (r = 0.348; p < 0.001). In the multivariate regression model for prediction of time until hospital admission, presence of intraventricular hemorrhage and the GCS score on admission were significant. In the multivariate regression model for prediction of a GCS score of ≧9 on admission, hematoma volume and time until hospital admission were significant parameters. Conclusions: Clinically more severely affected patients were admitted to hospital earlier. This highlights the importance of most rapid diagnosis of ICH. Efforts should be made to get less severely affected patients admitted earlier as they might be ideal candidates for emerging innovative treatments.

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Acute Ischemic Stroke

2006

Wiley Handbook of Current and Emerging Drug Therapies

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Variables Associated With Hospital Arrival Time After Stroke

Cited by 92 publications

References 20 publications

Benefits of a Prehospital Stroke Code System

Benefits of a Prehospital Stroke Code System

Clinical Severity Predicts Time to Hospital Admission in Patients with Spontaneous Intracerebral Hemorrhage

Acute Ischemic Stroke

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