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Social factors influencing hospital arrival time in acute ischemic stroke patients

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

This is a multi-center, hospital-based study aiming to estimate social factors influencing pre-hospital times of arrival in acute ischemic stroke, with a perspective of finding ways to reduce arrival time and to augment the number of patients eligible for intra-arterial thrombolysis.

Methods

Acute ischemic stroke patients who presented at the emergency units of four major general public hospitals were registered. We assessed information concerning demographics, time of presentation, clinical situation, imaging, treatment, and socioeconomic factors. The sample was divided in two sub-samples, based on the time of arrival since onset of symptoms, and was statistically analyzed.

Results

During one calendar year (2005), 907 patients were registered. Among them 34.6% arrived in the first 6 h from symptom onset, 38.7% arrived between 6 and 24 h, 18.1% after 24 h and for 8.6% the time of onset was unknown. Younger age (P = 0.007), transfer with ambulatory service (Ρ = 0.002), living with a mate (Ρ = 0.004), and higher educational level (P < 0.005) were factors which correlated significantly with early arrival at the hospital.

Conclusions

Instructing patients at high risk for stroke to live with a housemate appears beneficial for timely arrival at the hospital. The establishment of dedicated acute stroke call and transportation center should improve the percentage of early arrival. A national information campaign is needed to increase the level of awareness of the population concerning beneficial social behaviors and optimal reaction to symptoms of acute ischemic stroke.

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References

  1. Higashida RT, Halbach VV, Tsai FY, Dowd CF, Hieshima GB (1994) Interventional neurovascular techniques for cerebral revascularization in the treatment of stroke. AJR Am J Roentgenol 163:793–800

    PubMed  CAS  Google Scholar 

  2. Organised inpatient (stroke unit) care for stroke (2007) Cochrane Database Syst Rev.:CD000197

  3. Kjellstrom T, Norrving B, Shatchkute A (2007) Helsingborg declaration 2006 on European stroke strategies. Cerebrovasc Dis 23:231–241

    PubMed  CAS  Google Scholar 

  4. del Zoppo GJ, Higashida RT, Furlan AJ, Pessin MS, Rowley HA, Gent M (1998) Proact: A phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. Proact investigators. Prolyse in acute cerebral thromboembolism. Stroke 29:4–11

    Article  PubMed  Google Scholar 

  5. Ahmed N, Wahlgren N, Grond M, Hennerici M, Lees K, Mikulik R (2010) Implementation and outcome of thrombolysis with alteplase 3–4.5 h after an acute stroke: an updated analysis from SITS-ISTR. Lancet Neurol 9(9):843–845

    Article  Google Scholar 

  6. Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R et al (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). Jama 274:1017–1025

    Article  PubMed  CAS  Google Scholar 

  7. Smith WS et al (2008) Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 39(4):1205–1212

    Article  PubMed  Google Scholar 

  8. Khatri P, Hill MD, Palesch YY, Spilker J (2008) Methodology of the interventional management of stroke III trial, interventional management of stroke III investigators. Int J Stroke 3(2):130–137

    Article  PubMed  Google Scholar 

  9. Derex L, Adeleine P, Nighoghossian N, Honnorat J, Trouillas P (2002) Factors influencing early admission in a French stroke unit. Stroke 33:153–159

    Article  PubMed  Google Scholar 

  10. Rossnagel K, Jungehulsing GJ, Nolte CH, Muller-Nordhorn J, Roll S, Wegscheider K et al (2004) Out-of-hospital delays in patients with acute stroke. Ann Emerg Med 44:476–483

    Article  PubMed  Google Scholar 

  11. Inatomi Y, Yonehara T, Hashimoto Y, Hirano T, Uchino M (2008) Pre-hospital delay in the use of intravenous RT-PA for acute ischemic stroke in Japan. J Neurol Sci 270:127–132

    Article  PubMed  Google Scholar 

  12. Majersik JJ, Smith MA, Zahuranec DB, Sanchez BN, Morgenstern LB (2007) Population-based analysis of the impact of expanding the time window for acute stroke treatment. Stroke 38:3213–3217

    Article  PubMed  Google Scholar 

  13. Kleindorfer DO, Broderick JP, Khoury J, Flaherty ML, Woo D, Alwell K et al (2007) Emergency department arrival times after acute ischemic stroke during the 1990s. Neurocrit Care 7:31–35

    Article  PubMed  Google Scholar 

  14. Chandratheva A, Lasserson DS, Geraghty OC, Rothwell PM (2010) Population-based study of behavior immediately after transient ischemic attack and minor stroke in 1000 consecutive patients. Lessons for public education. Stroke 41(6):1108–1114

    Article  PubMed  Google Scholar 

  15. Silvestrelli G, Parnetti L, Tambasco N, Corea F, Capocchi G (2006) Characteristics of delayed admission to stroke unit. Clin Exp Hypertens 28:405–411

    Article  PubMed  Google Scholar 

  16. Tanaka Y, Nakajima M, Hirano T, Uchino M (2009) Factors influencing pre-hospital delay after ischemic stroke and transient ischemic attack. Intern Med 48:1739–1744

    Article  PubMed  Google Scholar 

  17. Prehospital and hospital delays after stroke onset—United States, 2005–2006 (2007). MMWR Morb Mortal Wkly Rep. 56:474–478

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We declare that we have no conflict of interest.

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Correspondence to Christina Iosif.

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Iosif, C., Papathanasiou, M., Staboulis, E. et al. Social factors influencing hospital arrival time in acute ischemic stroke patients. Neuroradiology 54, 361–367 (2012). https://doi.org/10.1007/s00234-011-0884-9

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  • DOI: https://doi.org/10.1007/s00234-011-0884-9

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