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http://dx.doi.org/10.14408/KJEMS.2020.24.2.027

An analysis of the causes of prehospital delays in patients with suspected acute stroke  

Lee, Nam-Jin (119 Emergency Medical Services Team, Daejeon Seobu Fire Station)
Moon, Jun-Dong (Department of Emergency Medical Service, Kongju National University)
Publication Information
The Korean Journal of Emergency Medical Services / v.24, no.2, 2020 , pp. 27-38 More about this Journal
Abstract
Purpose: Stroke is a time-sensitive disease that could have reduced complications and mortality with timely diagnosis and treatment. This study aimed to analyze the causes of delay in detecting the clinical signs and symptoms of stroke. Methods: This retrospective observational study analyzed the emergency medical services reports of suspected stroke patients with positive predictive values on the Cincinnati Prehospital Stroke Scale. The study was conducted in Daejeon, Republic of Korea from January 1, 2016 through December 31, 2017. Results: Prolonged prehospital time was associated with high blood pressure, history of cerebrovascular disease, and incidences during daily activities, and sleep. High blood pressure and complications from a previous stroke strongly associated with the prolonged stroke-detection phase (p<.05). Total prehospital time was shortened when patients had evident stroke symptoms, such as decreased level of consciousness, dysarthria, and hemiplegia (p<.05). There was no significant difference in gender or age as a factor that delayed the total prehospital time of the suspected stroke patients. Conclusion: Many patients did not recognize the early clinical symptoms and signs of a stroke. Furthermore, risk factors, such as high blood pressure and history of stroke, prolonged the total prehospital time. Therefore, we need targeted interventions that educate about warning symptoms of stroke, along with emphasis on the importance of emergency calls to substantially reduce the prehospital delays.
Keywords
Stroke; Prehospital delay; Emergency medical services;
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1 Fonarow GC, Smith EE, Saver JL Reeves MJ, Bhatt DL, Grau-Sepulveda MV et al. Timeliness of tissue-type plasminogen activator therapy in acute ischemic stroke: patient characteristics, hospital factors, and outcomes associated with door-to-needle times within 60 minutes. Circulation 2011;123:750-8. https://doi.org/10.1161/CIRCULATIONAHA.110.974675   DOI
2 Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870-947. https://doi.org/10.1161/STR.0b013e318284056a   DOI
3 Faiz KW, Sundseth A, Thommessen B, Ronning OM. Factors related to decision delay in acute stroke. J Stroke Cerebrovasc Dis 2014;23(3):534-9. https://doi. org/10.1016/j.jstrokecerebrovasdis.2013.05.007   DOI
4 Gonzalez-Aquines A, Cordero-Perez AC, Cristobal-Nino M, Perez-Vazquez G, Gongora -Rivera F, GECEN Investigators. Contribution of onset-to-alarm time to prehospital delay in patients with ischemic stroke. J Stroke Cerebrovasc Dis 2019;28(11):104331. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104331   DOI
5 Seno S, Tomura S, Ono K, Akitomi S, Sekine Y, Yoshimura Y et al. The relationship between functional outcome and prehospital time interval in patients with cerebral infarction. J Stroke Cerebrovasc Dis 2017;26(12):2800-5. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.06.059   DOI
6 O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010;376(9735):112-23. https://doi.org/10.1016/S0140-6736(10)60834-3   DOI
7 Lin CB, Peterson ED, Smith EE, Saver JL, Liang L, Xian Y et al. Emergency medical service hospital prenotification is associated with improved evaluation and treatment of acute ischemic stroke. Circulation Cardiovasc Qual Outcomes 2012;5(4):514-22. https://doi.org/10.1161/CIRCOUTCOMES.112.965210   DOI
8 Barsan WG, Brott TG, Broderick JP, Haley EC, Levy DE, Marler JR. Time of hospital presentation in patients with acute stroke. Arch Intern Med 1993;153(22):2558-61.PMID:7598755   DOI
9 Bornstein NM, Gur AY, Fainshtein P, Korczyn AD. Stroke during sleep: epidemiological and clinical features. Cerebrovasc Dis 1999;9(6):320-2. https://doi.org/10.1159/000016005   DOI
10 Montaner J, Vidal C, Molina C, Alvarez-Sabin J. Selecting the target and the message for a stroke public education campaign: a local survey conducted by neurologists. Eur J Epidemiol 2001;17(6):581-6. https://doi.org/10.1023/a:1014581003849   DOI
11 Foulkes MA, Wolf PA, Price TR, Mohr JP, Hier DB. The Stroke Data Bank: design, methods, and baseline characteristics. Stroke 1988;19(5):547-54. https://doi.org/10.1161/01.str.19.5.547   DOI
12 Bogousslavsky J, Van Melle G, Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke 1988;19(9):1083-92. https://doi.org/10.1161/01.str.19.9.1083   DOI
13 Kleindorfer D, Lindsell CJ, Moomaw CJ, Alwell K, Woo D, Flaherty ML et al. Which stroke symptoms prompt a 911 call? A population-based study. Am J Emerg Med 2010;28(5):607-12. https://doi.org/10.1016/j.ajem.2009.02.016   DOI
14 Gardener H, Pepe PE, Rundek T, Wang K, Dong C, Ciliberti M et al. Need to prioritize education of the public regarding stroke symptoms and faster activation of the 9-1-1 System: Findings from the Florida-Puerto Rico CReSD Stroke Registry. Prehosp Emerg Care 2019;23(4):439-46. https://doi.org/10.1080/10903127.2018.1525458   DOI
15 Kothari R, Sauerbeck L, Jauch E, Broderick J, Brott T, Khoury J et al. Patients' awareness of stroke signs, symptoms, and risk factors. Stroke 1997;28(10):1871-5. https://doi.org/10.1161/01.str.28.10.1871   DOI
16 Gargano JW, Wehner S, Reeves MJ. Presenting symptoms and onset-to-arrival time in patients with acute stroke and transient ischemic attack. J Stroke Cerebrovasc Dis 2011;20(6):494-502. https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.02.022   DOI
17 Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke 2018;49(3):e46-e99. https://doi.org/10.1161/STR.0000000000000158   DOI