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Factors associated with early hospital arrival in acute ischemic stroke patients

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Abstract

Early diagnosis and treatment in acute ischemic stroke are crucial in terms of survival and disability. Many stroke patients remain disabled because of the treatment delay. The purpose of this study was to investigate the factors associated with the early hospital arrival in acute ischemic stroke patients. 113 patients diagnosed with acute ischemic stroke were included in this prospective study performed at the Karadeniz Technical University Medical Faculty Hospital. Patients’ characteristics and patients’ and relatives’ emotional and behavioral reactions were compared between early (within 3 h) and late (after 3 h) arrival groups. 72.6 % of patients arrived at hospital within 3 h from symptoms onset. Univariate analysis revealed that history of atrial fibrillation (p = 0.04) and coronary heart disease (p = 0.02), sudden onset of symptoms (p = 0.001), loss of consciousness (p = 0.03), recognizing symptoms as stroke (p = 0.01), seeking immediate medical attention (p < 0.001), feelings of fear and panic (p = 0.001), arriving at hospital by ambulance having called the emergency medical services (p = 0.04) and National Institute of Health Stroke Scale (NIHSS) score (p = 0.001) were associated with hospital arrival within 3 h. A multivariate regression model demonstrated that recognizing symptoms as stroke (OR, 3.4; 95 % CI, 1.2–9.3) and atrial fibrillation (OR, 4.3; 95 % CI, 1.1–15.7) were independent factors associated with early arrival. The role in early arrival at hospital of recognizing symptoms as stroke and seeking immediate medical attention with transportation by ambulance emphasize the importance of public awareness concerning recognizing the symptoms of stroke and accessing emergency medical assistance.

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References

  1. Millan M, Davalos A (2006) The need for new therapies for acute ischaemic stroke. Cerebrovasc Dis 22:3–9

    Article  Google Scholar 

  2. Chen CH, Huang P, Yang YH, Liu CK, Lin TJ, Lin RT (2007) Pre-hospital and in-hospital delays after onset of acute ischemic stroke: a hospital-based study in southern Taiwan. Kaohsiung J Med Sci 23:552–559

    Article  PubMed  CAS  Google Scholar 

  3. Turan TN, Hertzberg V, Weiss P, McClellan W, Presley R, Krompf K, Karp H, Frankel MR (2005) Clinical characteristics of patients with early hospital arrival after stroke symptom onset. J Stroke Cerebrovasc Dis 14:272–277

    Article  PubMed  Google Scholar 

  4. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587

    Article  Google Scholar 

  5. Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP et al (2004) Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363:768–774

    Article  PubMed  Google Scholar 

  6. Wardlaw JM, Warlow CP (1992) Thrombolysis in acute ischemic stroke: does it work? Stroke 23:1826–1839

    Article  PubMed  CAS  Google Scholar 

  7. Davalos A, Castillo J, Martinez-Vila E (1995) Delay in neurological attention and stroke outcome. Cerebrovascular Diseases Study Group of the Spanish Society of Neurology. Stroke 26:2233–2237

    Article  PubMed  CAS  Google Scholar 

  8. Moloczij N, McPherson KM, Smith JF, Kayes NM (2008) Help-seeking at the time of stroke: stroke survivors’ perspectives on their decisions. Health Soc Care Community 16:501–510

    Article  PubMed  Google Scholar 

  9. Silvestrelli G, Parnetti L, Paciaroni M, Caso V, Corea F, Vitali R, Capocchi G, Agnelli G (2006) Early admission to stroke unit influences clinical outcome. Eur J Neurol 13:250–255

    Article  PubMed  CAS  Google Scholar 

  10. 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 

  11. Iosif C, Papathanasiou M, Staboulis E, Gouliamos A (2012) Social factors influencing hospital arrival time in acute ischemic stroke patients. Neuroradiology 54:361–367

    Article  PubMed  Google Scholar 

  12. Jin H, Zhu S, Wei JW, Jin H, Zhu S, Wei JW et al (2012) Factors associated with pre-hospital delays in the presentation of acute stroke in urban China. Stroke 43:362–370

    Article  PubMed  Google Scholar 

  13. Lacy CR, Suh DC, Bueno M, Kostis JB (2001) Delay in presentation and evaluation for acute stroke: Stroke Time Registry for Outcomes Knowledge and Epidemiology (STROKE). Stroke 32:63–69

    Article  PubMed  CAS  Google Scholar 

  14. Nowacki P, Nowik M, Bajer-Czajkowska A, Porebska A, Zywica A, Nocoń D, Drechsler H, Safranow K (2007) Patients’ and bystanders’ awareness of stroke and pre-hospital delay after stroke onset: perspectives for thrombolysis in West Pomerania Province, Poland. Eur Neurol 58:159–165

    Article  PubMed  Google Scholar 

  15. Teuschl Y, Brainin M (2010) Stroke education: discrepancies among factors influencing pre-hospital delay and stroke knowledge. Int J Stroke 5:187–208

    Article  PubMed  Google Scholar 

  16. Chang KC, Tseng MC, Tan TY (2004) Pre-hospital delay after acute stroke in Kaohsiung, Taiwan. Stroke 35:700–704

    Article  PubMed  Google Scholar 

  17. Rosamond WD, Gorton RA, Hinn AR, Hohenhaus SM, Morris DL (1998) Rapid response to stroke symptoms: the Delay in Accessing Stroke Healthcare (DASH) study. Acad Emerg Med 5:45–51

    Article  PubMed  CAS  Google Scholar 

  18. Wester P, Radberg J, Lundgren B, Peltonen M (1999) Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA: a prospective, multicenter study. Seek- Medical-Attention-in-Time Study Group. Stroke 30:40–48

    Article  PubMed  CAS  Google Scholar 

  19. Kim YS, Park SS, Bae HJ, Cho AH, Cho YJ, Han MK et al (2011) Stroke awareness decreases pre-hospital delay after acute ischemic stroke in Korea. BMC Neurol 11:2

    Article  PubMed  PubMed Central  Google Scholar 

  20. Feldmann E, Gordon N, Brooks JM, Brass LM, Fayad PB, Sawaya KL, Nazareno F, Levine SR (1993) Factors associated with early presentation of acute stroke. Stroke 24:1805–1810

    Article  PubMed  CAS  Google Scholar 

  21. Morris DL, Rosamond W, Madden K, Schultz C, Hamilton S (2000) Pre-hospital and emergency department delays after acute stroke: the Genentech stroke presentation survey. Stroke 31:2585–2590

    Article  PubMed  CAS  Google Scholar 

  22. Mandelzweig L, Goldbourt U, Boyko V, Tanne D (2006) Perceptual, social, and behavioral factors associated with delays in seeking medical care in patients with symptoms of acute stroke. Stroke 37:1248–1253

    Article  PubMed  Google Scholar 

  23. Keskin O, Kalemoglu M, Ulusoy RE (2005) A clinic investigation into pre-hospital and emergency department delays in acute stroke care. Med Princ Pract 14:408–412

    Article  PubMed  Google Scholar 

  24. Memis S, Tugrul E, Evci ED, Ergin F (2008) Multiple causes for delay in arrival at hospital in acute stroke patients in Aydin, Turkey. BMC Neurol 8:15

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Karadeniz Technical University Medical Faculty, 61080, Trabzon, Turkey

    Esin Kulein Koksal, Sibel Gazioglu, Cavit Boz & Zekeriya Alioglu

  2. Department of Public Health, Karadeniz Technical University Medical Faculty, 61080, Trabzon, Turkey

    Gamze Can

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  1. Esin Kulein Koksal
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  2. Sibel Gazioglu
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  3. Cavit Boz
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  4. Gamze Can
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  5. Zekeriya Alioglu
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Correspondence to Sibel Gazioglu.

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Koksal, E.K., Gazioglu, S., Boz, C. et al. Factors associated with early hospital arrival in acute ischemic stroke patients. Neurol Sci 35, 1567–1572 (2014). https://doi.org/10.1007/s10072-014-1796-3

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  • DOI: https://doi.org/10.1007/s10072-014-1796-3

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