Acute Ischemic Stroke Patients In Tai’an City Analysis Of Influencing Factors Of Pre-hospital Delay And Strategies

Objectives To provide evidence and protocol for the prevention and control of acute ischemic stroke(AIS),pre-hospital delay in AIS patients from five hospitals in Tai’an was investigated on the basis of learning the distribution of pre-hospital delay,and factors involving pre-hospital delay were analyzed to shorten the pre-hospital time effectively.Methods 1.On the basis of the existing questionnaires,a questionnaire on the status of pre-hospital delays in patients with AIS was revised and formed by consulting the literature.The questionnaire consisted of four domains: basic data,disease-related data,stroke cognition and trait coping style.Patients with AIS were selected and survived from departments of neurology in five hospitals from September to December 2018 by convenience sampling method.2.Excel 2007 and SPSS were used to analyze data.Descriptive statistical analysis was used.Classified data were expressed by frequency,percentage and composition ratio.The measurement data are expressed by means±standard deviation(sx ±).Two groups of data were analyzed by single factor analysis.Measurement data were analyzed by t test.Classified data were analyzed by χ2 test,and time data were analyzed by non-parametric two-sample statistical method.Logistic regression analysis was used for multivariate analysis.All P<0.05 are considered significant.Results In this study,360 patients with AIS were survied.22 questionnaires were excluded,and 338 valid questionnaires were included,with an effective recovery rate of 93.89%.1.Pre-hospital delays in patients with AIS in Tai’an hospitals Among 338 AIS patients,pre-hospital time(the Onset-to-Door time at the hospital with stroke treatment ability)was 22.41±50.61 hours,and the median time was 3.33 hours.Decision time(the time from onset to decision)was 9.39±36.52 hours,and the median time was 0.75 hours.Transportation time(the time from admission to the hospital with stroke treatment ability)was 13.01±36.41 hours,and the median time was 1.50 hours.150 cases(44.38%)were treated within 3 hours and 188 cases(55.62%)did not reach the hospital within 3 hours.2.Influencing factors of pre-hospital delay in patients with AIS in Tai’an hopitals(1)Univariate analysis showed that the education level(P=0.015),medical insurance type(P=0.035),monthly income per family(P=0.021),age(P=0.039),initial symptoms of severe headache,vomiting(P=0.020),place of residence(P<0.001),distance between onset site and first medical place.(P<0.001),first medical place(P<0.001),referral(P<0.001),first measures(P<0.001),whether to use Emergency Medical System(EMS),stroke symptom identification score(t=5.56,P<0.001),stroke risk factor identification score(t=4.494,P<0.001),positive after onset.There were significant differences in coping styles(PC)(t=2.325,P=0.021),and negative coping styles(NC)(t=-4.766,P<0.01).(2)Logistic regression analysis: The potential factors for shortening pre-hospital time(protective factors)were Emergency Medical Service(EMS)system(OR=0.047),positive coping style(OR=0.752),high level of stroke awareness(OR=0.72).The potential factors delaying pre-hospital time(risk factors)were living the countryside(OR=5.643),history of cerebral infarction(OR=2.754),referral(OR=43.685),and negative coping style(OR=1.667).Conclusions 1.Of 338 patients with AIS in Tai’an hospitals,150(44.38%)were treated within 3 hours and 188(55.62%)did not reach the hospital within 3 hours.The pre-hospital delay was considered as serious issues for AIS patients’ management.2.The potential influencing factors of pre-hospital delay in patients with AIS in Tai’an hospitals were age,place of residence,history of cerebral infarction,referral,EMS use,cognitive level of stroke and coping style.3.The strategies for shortening pre-hospital time of AIS patients were established to improve the efficiency of AIS management in Tai’an city.(1)it is very important to formulate a comprehensive education program to improve the public’s awareness of stroke;(2)we should improve the EMS to smooth the channels of stroke treatment;(3)we should accelerate the construction of regional stroke treatment system and build a golden stroke treatment circle;(4)we should increase investment in the construction of rural medical institutions and improve rural medical conditions;and(5)we should avoid the elderly living alone and strengthen and social family support system.