Time to presenting to hospital and associated factors in stroke patients
OBJECTIVE:To investigate multifaceted factors that constrain early stroke treatment, from both clinical and social standpoints.
METHODS: This was a cross-sectional study conducted at a general hospital in northern Japan. Data on time to presenting to hospital after stroke onset and its potential associated factors were retrospectively extracted from the medical records of hospitalised stroke patients and analysed.
RESULTS:Median time of presenting to hospital after stroke onset for 287 patients was 12 hours (range, 0.4–347 hours), and 16.7% of cases presented within 2 hours of onset. Multivariate analysis revealed a significant level of association between a Japan Coma Scale score of ≥1 (OR = 0.41; 95% CI, 0.20–0.86) and cardiogenic cerebral embolism (OR = 0.36; 95% CI, 0.15–0.85). The proportions of patients treated with recombinant tissue plasminogen activator, those with a Modified Rankin Scale score of ≥2, and those in a rehabilitation hospital/long-term care ward or who died were significantly higher among patients who presented within 2 hours.
CONCLUSION: Less than one fifth of our stroke patients presented to hospital within 2 hours. Although our results are preliminary given their limited generalisability and the retrospective nature of data collection, medical rather than social factors were found to be associated with time of presenting to hospital. Patients with severe symptoms presented to the hospital at an earlier stage after stroke onset. It is important to promote the earliest possible presentation to hospital after a stroke.
- Nakagawara J. Present state of stroke emergency in Japan. Brain Nerve. 2010;62(1):25–34.
- Stop! Stroke. http://www.jsa-web.org/ (in Japanese)
- Pancioli AM, Broderick J, Kothari R, Brott T, Tuchfarber A, Miller R, et al. Public perception of stroke warning signs and knowledge of potential risk factors. JAMA. 1998;279(16):1288–92.
- Casetta I, Granieri E, Gilli G, Lauria G, Tola MR, Paolino E. Temporal trend and factors associated with delayed hospital admission of stroke patients. Neuroepidemiology. 1999;18(5):255–64.
- Moser DK, Kimble LP, Alberts MJ, Alonzo A, Croft JB, Dracup K, et al. Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: a scientific statement from the American Heart Association Council on cardiovascular nursing and stroke council. Circulation. 2006;114(2):168–82. Epub 2006 Jun 26.
- Tanaka Y, Nakajima M, Hirano T, Uchino M. Factors influencing pre-hospital delay after ischemic stroke and transient ischemic attack. Intern Med. 2009;48(19):1739–44. Epub 2009 Oct 1.
- Mosley I, Nicol M, Donnan G, Patrick I, Dewey H. Stroke symptoms and the decision to call for an ambulance. Stroke. 2007;38(2):361–6. Epub 2007 Jan 4.
- Scott PA, Temovsky CJ, Lawrence K, Gudaitis E, Lowell MJ. Analysis of Canadian population with potential geographic access to intravenous thrombolysis for acute ischemic stroke. Stroke. 1998;29(11):2304–10.
- Kleindorfer D, Xu Y, Moomaw CJ, Khatri P, Adeoye O, Hornung R. US geographic distribution of rt-PA utilization by hospital for acute ischemic stroke. Stroke. 2009;40(11):3580–4. Epub 2009 Oct 1.
- Increment P Corporation. MapFan Web. http://www.mapfan.com/routemap/routeset.cgi
- Iguchi Y, Wada K, Shibazaki K, Inoue T, Ueno Y, Yamashita S, Kimura K. First impression at stroke onset plays an important role in early hospital arrival. Intern Med. 2006;45(7):447–51. Epub 2006 May 1.
- Kimura K, Kazui S, Minematsu K, Yamaguchi T. Japan Multicenter Stroke Investigator's Collaboration. Analysis of 16,922 patients with acute ischemic stroke and transient ischemic attack in Japan. A hospital-based prospective registration study. Cerebrovasc Dis. 2004;18(1):47–56. Epub 2004 Jun 1.
- Wester P, Rådberg J, Lundgren B, Peltonen M. 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. 1999;30(1):40–8.
- Fogelholm R, Murros K, Rissanen A, Ilmavirta M. Factors delaying hospital admission after acute stroke. Stroke. 1996;27(3):398–400.
- Kothari R, Jauch E, Broderick J, Brott T, Sauerbeck L, Khoury J, Liu T. Acute stroke: delays to presentation and emergency department evaluation. Ann Emerg Med. 1999;33(1):3–8.
- Edlow JA, Kim S, Pelletier AJ, Camargo CA Jr. National study on emergency department visits for transient ischemic attack, 1992–2001. Acad Emerg Med. 2006;13(6):666–72. Epub 2006 Apr 11.
- Rothwell PM, Giles MF, Chandratheva A, Marquardt L, Geraghty O, Redgrave JN, et al. Early use of Existing Preventive Strategies for Stroke (EXPRESS) study. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet. 2007;370(9596):1432–42.
- Luengo-Fernandez R, Gray AM, Rothwell PM. Effect of urgent treatment for transient ischaemic attack and minor stroke on disability and hospital costs (EXPRESS study): a prospective population-based sequential comparison. Lancet Neurol. 2009;8(3):235–43. Epub 2009 Feb 4.
- Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007;369(9558):283–92.
- Lavallée PC, Meseguer E, Abboud H, Cabrejo L, Olivot JM, Simon O, et al. A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol. 2007;6(11):953–60.
- Nedeltchev K, Renz N, Karameshev A, Haefeli T, Brekenfeld C, Meier N, et al. Predictors of early mortality after acute ischaemic stroke. Swiss Med Wkly. 2010;140(17-18):254–9.