Factors Associated With Pre- And In-Hospital Delays For Acute Ischemic Stroke Patients

Objective: To identify the main causes of pre-hospital and in-hospital delays for theacute ischemic stroke patients, especially for residents of Guangzhou. Methods: 147 diagnosed acute ischemic stroke patients were collected and analyzedin our hospital from December 2002 to December 2003. 116 patients (78.9%) were hospitalized to the neurology department directly, average age: 64.97 9.56. To record clinical and demographic data, the neurological disorders by Barthel Index (BI), the stroke knowledge of the patients and their caregivers if the patients had no conscious disorder, using EMS, the Delay time of Pre- and In-Hospital, as well as whether the delay occurred in the community hospital or clinic. 31 patients (21.1%) were missed diagnosis, average age: 65.10 12.91.We retrospective investigated the missed diagnoses patients.Exact binary logistic regression was used to predict the delay time. For the in-hospital delay, we calculated the time during every detailed diagnoses and treatment flow, and proceeded to descriptive analyses.Results: For hospitalized patients via emergency department, the median delaytime from onset to getting emergency department is about 5.50 hours, the median delay time from the emergency to hospitalization is 1.85 hours, and from hospitalization to getting treatment is 0.5 hour. But for patients via neurology out-patient, the median delay time from onset to out-patient is longer, about 38.00 hours, and the median delay time from out-patient to getting treatment is 2.50 hours. 26.2 % patients arrived within 3 hours and 33.3% within 6 hours, 53.1% patients know "what is the stroke?", only 22.2% patients know the best time to be treated is in 6 hours. 32.1% patients know the place to be treated is at neurology department, and only19.0% activated EMS by calling 120,After the binary logistic regression, the most related factors are education(P:0.039; OR:0.466), BI(P:0.001; Ctf:0.268), stroke symptom recognition of patients(P:0.040; OR:0.225), the delay of the community hospital or clinic(P:0.049; OR:9.831), et al.Conclusions: Education, BI, stroke symptom recognition of patients and the delay of the community hospital or clinic are related with the delays, so we have to consider all kinds of ways to educate the residents, and make them easier to recognize the stroke, if the stroke is acute in onset, they can try their best to contact with the EMS, or to see a doctor in the shortest time. Additionally, it is very important and necessary to introduce the special course about the stroke to the doctors of community hospitals and clinics. For our hospital, all the related departments (including the neurology department, emergency department and the image department) should cooperate closely, so that we can reduce the delay time during the hospital to get easily diagnosis and proper treatment.