Kaohsiung Journal of Medical Sciences
Volume 23, Issue 11 , Pages 552-559, November 2007

Pre-hospital and In-hospital Delays After Onset of Acute Ischemic Stroke—A Hospital-based Study in Southern Taiwan

  • Chun-Hung Chen

      Affiliations

    • Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Poyin Huang

      Affiliations

    • Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Yuan-Han Yang

      Affiliations

    • Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Ching-Kuan Liu

      Affiliations

    • Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Tzeng-Jih Lin

      Affiliations

    • Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Ruey-Tay Lin

      Affiliations

    • Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Corresponding Author InformationAddress correspondence and reprint requests to: Dr Ruey-Tay Lin, Department of Neurology, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung 807, Taiwan

Received 26 April 2007; accepted 25 June 2007.

Article Outline

The biggest hurdle for early hospital presentation is the narrow therapeutic window after stroke. The aims of our study were to investigate the time lags and the factors causing pre-hospital and emergency department (ED) delay during acute ischemic stroke attack. Between June 2004 and October 2005, we prospectively studied 129 acute ischemic stroke patients who presented to the ED of the study hospital within 4 hours after symptom onset. Chi-square testing for trend, uni-variate and multiple logistic regression analyses was performed to evaluate the factors influencing delays in the ED presentation of acute ischemic stroke patients. The median time from symptom onset to ED arrival was 71 (mean ± SD, 82.7 ± 57.7) minutes. The median times from ED arrival to neurologic consultation, computed tomography scan, electrocardiogram, and laboratory data completion were 10 (11.3±9.9) minutes, 17 (9.6±11.3) minutes, 14 (23.3±55) minutes, and 39 (44.4±24.5) minutes, respectively. Univariate and multiple logistic regression models revealed that age < 65 years, illiteracy and awakening with symptoms were the most significant factors related to a delay in ED presentation. This study indicates that 2 hours of pre-hospital delay is the cutoff point for thrombolytic therapy. Organization of a stroke team and standardized stroke pathways may help to shorten in-hospital time consumption. Educational efforts should not only focus on the public, but also on the training of ED physicians and other medical personnel.

Key Words:  acute ischemic stroke , standardized pathway , stroke team , time lag

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Sarti C , Rastenyte D , Cepaitis Z , et al.   International trends in mortality from stroke, 1968 to 1994 . Stroke . 2000;31:1588–1601
  2. Department of Health  , Executive Yuan of the Republic of China  . Taiwan Public Health Report, 2005 . Taipei, Taiwan: R.O.C.; 2005;
  3. Huang ZS , Chiang TL , Lee TK . Stroke prevalence in Taiwan: findings from the 1994 National Health Interview Survey . Stroke . 1997;28:1579–1584
  4. Hu HH , Sheng WY , Chu FL , et al.   Incidence of stroke in Taiwan . Stroke . 1992;23:1237–1241
  5. Baron JC , von Kummer R , del Zoppo GJ . Treatment of acute ischemic stroke: challenging the concept of a rigid and universal time window . Stroke . 1995;26:2219–2221
  6. Dorman PJ , Sandercock PAG . Considerations in the design of clinical trials of neuroprotective therapy in acute stroke . Stroke . 1996;27:1507–1515
  7. The National Institute of Neurological Disorders and Stroke rt-PA stroke Study Group  . Tissue plasminogen activator for acute ischemic stroke . N Engl J Med . 1995;333:1581–1587
  8. Barper PA , Zhang J , Demchuk AM , et al.   Why are stroke patients excluded from TPA therapy? An analysis of patient eligibility . Neurology . 2001;56:1015–1020
  9. Lacy C , Suh D , Bueno M , Kostis J  for the STROKE Collaborative Study Group . Delay in presentation and evaluation for acute stroke: Stroke Time Registry for Outcome Knowledge and Epidemiology (STROKE) . Stroke . 2001;32:63–69
  10. Harraf F , Sharma AK , Brown M , et al.   A multi-center observational study of presentation and assessment of acute stroke . BMJ . 2002;325:17–20
  11. Chang KC , Tseng MC , Tan TY . Prehospital delay after acute stroke in Kaohsiung, Taiwan . Stroke . 2004;35:700–704
  12. Derex L , Adeleine P , Nihhoghossian N , et al.   Factors influencing early admission in a French stroke unit . Stroke . 2002;33:153–159
  13. Rossnagel K , Jungehulsing GJ , Muller-Nordhorn J , et al.   Out-of-hospital delays in patients with acute stroke . Ann Emerg Med . 2004;44:476–483
  14. Adams HP , Davis PH , Leira EC , et al.   Baseline NIH Stroke Scale score strongly predicts outcome after stroke: a report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) . Neurology . 1999;53:126–131
  15. DeGraba TJ , Hallenbeck JM , Pettigrew KD , et al.   Progression in acute stroke: value of the initial NIH Stroke Scale score on patient stratification in future trials . Stroke . 1999;30:1208–1212
  16. National Institute of Neurological Disorders and Stroke. Proceedings of a National Symposium on Rapid Identification and Treatment of Acute Stroke, Washington, 1997.
  17. Wester P , Radberg J , Lundgren B , Peltonen M , for the Seek Medical Attention in Time Study Group  . Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA: a prospective, multicenter study . Stroke . 1999;30:40–48
  18. Morris DL , Rosamond W , Madden K , et al.   Prehospital and emergency department delays after acute stroke: the Genentech Stroke Presentation Survey . Stroke . 2000;31:2585–2590
  19. Jorgensen HS , Nakayama H , Reith J , et al.   Factors delaying hospital admission in acute stroke: the Copenhagen Stroke Study . Neurology . 1996;47:383–387
  20. Broadley SA , Thompson PD . Time to hospital admission for acute stroke: an observational study . Med J Aust . 2003;178:329–331
  21. Keskin O , Kalemoglu M , Ulusoy RE . A clinical investigation into prehospital and emergency department delays in acute stroke care . Med Princ Pract . 2005;14:408–412
  22. Kothari R , Sauerbeck L , Jauch E , et al.   Patients' awareness of stroke signs, symptoms, and risk factors . Stroke . 1997;28:1871–1875
  23. Yu RF , San Jose MC , Manzanilla BM , et al.   Sources and reasons for delays in the care of acute stroke patients . J Neuro Sci . 2002;199:49–54
  24. Lin CS , Tsaqi J , Woo P , Chang H . Prehospital delay and emergency department management of ischemic stroke patients in Taiwan, R.O.C. . Prehosp Emerg Care . 1999;3:194–200
  25. Kwan J , Hand P , Sandercock P . Improving the efficiency of deliver of thrombolysis for acute stroke: a systemic review . Q J Med . 2004;97:273–279

PII: S1607-551X(08)70002-0

doi:10.1016/S1607-551X(08)70002-0

Kaohsiung Journal of Medical Sciences
Volume 23, Issue 11 , Pages 552-559, November 2007

Article Tools