Prehospital Factors Associated with Delayed Hospital Arrival of Stroke Patients: A Regional Single-Center Study from India

Sachin Edakkattil, S. Abraham, Neenu J. Panattil, Faris A. Gafoor, Leenus Jacob, Renyu Liu
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Abstract

Only a small percentage of patients with acute stroke are currently eligible for thrombolysis, partly due to severe delays in hospital arrival. We had previously conducted the first regional study to assess the factors delaying acute stroke care in India. The present study aims to understand and describe in depth the variables associated with prehospital delay among patients admitted with an acute ischemic stroke. Data were prospectively collected by conducting an in-depth interview of 470 acute ischemic stroke patients and their bystanders, aged above 18 years, presenting to the Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur. Patients who arrived within 4.5 h of symptom onset were considered as “early arrival” and those who arrived after 4.5 h were considered as “delayed arrival.” Univariate and multivariate analyses were undertaken to determine associations between variables of interest and delays to hospital presentation. Of the 470 patients who met the inclusion criteria, 73 patients reached within 4.5 h (15.5%), whereas 397 patients arrived after 4.5 h. The mean age of acute stroke patients who reached within 4.5 h was 63 ± 13.7 years, whereas the mean age of those who reached after 4.5 h was 63 ± 12.1 years. Binary logistic regression performed to quantify the associations of prehospital factors showed an increased risk of prehospital delay among individuals with lack of awareness (odds ratio [OR] = 5.16 [3.040–8.757], P < 0.001), followed by those for whom a vehicle was not available at the site of event (OR = 3.745 [1.864–7.522], P < 0.001). Within the predefined socioeconomic strata, compared to lower class, upper middle class had less risk (OR = 0.135 [0.018–1.035], P = 0.054), whereas the distance from first medical contact to emergency department contributed moderate risk (OR = 1.071 [1.028–1.116], P < 0.001) for prehospital delay. Health promotion techniques that increase public knowledge about the early signs of stroke, transferring patients directly to hospitals with thrombolysis capabilities, and making ambulance services more widely available are appropriate measures to reduce prehospital delay.
与中风患者延迟到达医院有关的院前因素:印度地区单中心研究
目前,只有一小部分急性中风患者有资格接受溶栓治疗,部分原因是到达医院的时间严重滞后。此前,我们在印度开展了首个地区性研究,评估急性中风救治延误的因素。本研究旨在深入了解和描述与急性缺血性脑卒中患者院前延误相关的变量。 本研究通过对 470 名到位于 Thrissur 的 Jubilee Mission 医学院和研究所急诊科就诊的 18 岁以上急性缺血性中风患者及其旁观者进行深入访谈,前瞻性地收集了数据。症状出现后 4.5 小时内到达的患者被视为 "早期到达",4.5 小时后到达的患者被视为 "延迟到达"。通过单变量和多变量分析来确定相关变量与延迟入院之间的关系。 在符合纳入标准的 470 名患者中,73 名患者在 4.5 小时内到达医院(15.5%),397 名患者在 4.5 小时后到达医院。为量化院前因素的相关性而进行的二元逻辑回归显示,缺乏意识的患者院前延误的风险增加(几率比 [OR] = 5.16 [3.040-8.757],P < 0.001),其次是事件发生地没有车辆的患者(OR = 3.745 [1.864-7.522],P < 0.001)。在预定义的社会经济阶层中,与下层阶级相比,中上层阶级发生院前延误的风险较低(OR = 0.135 [0.018-1.035],P = 0.054),而从首次医疗接触到急诊科的距离造成院前延误的风险适中(OR = 1.071 [1.028-1.116],P < 0.001)。 提高公众对脑卒中早期征兆的认识、将患者直接转送至具备溶栓能力的医院、更广泛地提供救护车服务等健康促进技术是减少院前延误的适当措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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