Factors Associated With Prehospital Delay In Acute Stroke

Objective：To observe the time interval between stroke onset and hospital arrival (time-to-hospital) inacute ischemic stroke patients and analyze its putatively associated factors.Methods：During the period from March2011to November2011, patients with acute ischemic strokeadmitted consecutively to the department of neurology, two Grade three hospitals, WuHan,were enrolled in the study. Information of the patients was registered includingdemographic data, the time-to-hospital, associated factors and patient′s conditions.2h and3.5h as the boundary, those factors were analyzed and logistic regression analyses wereconducted to identify factors associated with the time-to-hospital.Results：There were121patients in the study. The median time-to-hospital was23.75h (4.33-82.81).1. Patients with a history of atrial fbrillation;2.near to hospital;3.recognition of symptomby witness, unconsciousness at onset;4.present to hospital by120, car or taxi, first presentto hospital of Grade2and above;5.stroke type of cardioembolism had signifcantlyassociated with shorter time-to-hospital.1.With a history of diabetes mellitus;2.notice athome;3.referral from other hospital had signifcantly associated with longer time-to-hospital. Multivariate logistic regression showed that recognition of symptom bywitness, unconsciousness at onset, first present to hospital of Grade2and above werepositively related to non-delayed arrival; but notice at home, referral from other hospital,present to hospital by other vehicle were negatively related to non-delayed arrival.Conclusion：Delayed arrival have following reasons:1. Many patients and caregivers apparently do notknow about the risk factors, clinic symptoms and emergency of stroke, also do not presentpatients to hospital by120, car or taxi as soon as possible.2.Our acute stroke emergencesystem was not perfect, many patients first present to Grade one hospitals that do not havestroke thrombolysis capabilities result in over the time of thrombolysis when they arrival.In order to reduce the prehospital delay time and actually benefit the patients, patients andtheir family, medical workers, society need to jointly participate, take a variety of ways toestablish and improve the corresponding mechanism.