Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients.

Kielkopf, Moritz; Meinel, Thomas; Kaesmacher, Johannes; Fischer, Urs; Arnold, Marcel; Heldner, Mirjam; Seiffge, David; Mordasini, Pasquale; Dobrocky, Tomas; Piechowiak, Eike; Gralla, Jan; Jung, Simon (2020). Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients. Journal of clinical medicine, 9(8) MDPI 10.3390/jcm9082376

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(1) Background: The benefit of acute ischemic stroke (AIS) treatment declines with any time delay until treatment. Hence, factors influencing the time from symptom onset to admission (TTA) are of utmost importance. This study aimed to assess temporal trends and risk factors for delays in TTA. (2) Methods: We included 1244 consecutive patients from 2015 to 2018 with suspected stroke presenting within 24 h after symptom onset registered in our prospective, pre-specified hospital database. Temporal trends were assessed by comparing with a cohort of a previous study in 2006. Factors associated with TTA were assessed by univariable and multivariable regression analysis. (3) Results: In 1244 patients (median [IQR] age 73 [60-82] years; 44% women), the median TTA was 96 min (IQR 66-164). The prehospital time delay reduced by 27% in the last 12 years and the rate of patients referred by Emergency medical services (EMS) increased from 17% to 51% and the TTA for admissions by General Practitioner (GP) declined from 244 to 207 min. Factors associated with a delay in TTA were stroke severity (beta-1.9; 95% CI-3.6 to -0.2 min per point NIHSS score), referral by General Practitioner (GP, beta +140 min, 95% CI 100-179), self-admission (+92 min, 95% CI 57-128) as compared to admission by emergency medical services (EMS) and symptom onset during nighttime (+57 min, 95% CI 30-85). Conclusions: Although TTA improved markedly since 2006, our data indicates that continuous efforts are mandatory to raise public awareness on the importance of fast hospital referral in patients with suspected stroke by directly informing EMS, avoiding contact of a GP, and maintaining high effort for fast transportation also in patients with milder symptoms.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Kielkopf, Moritz Christopher; Meinel, Thomas Raphael; Kaesmacher, Johannes; Fischer, Urs; Arnold, Marcel; Heldner, Mirjam Rachel; Seiffge, David Julian; Mordasini, Pasquale; Dobrocky, Tomas; Piechowiak, Eike Immo; Gralla, Jan and Jung, Simon

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2077-0383

Publisher:

MDPI

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

30 Jul 2020 10:57

Last Modified:

30 Jul 2020 10:57

Publisher DOI:

10.3390/jcm9082376

PubMed ID:

32722432

Uncontrolled Keywords:

prehospital delay prior stroke stroke time to admission

BORIS DOI:

10.7892/boris.145478

URI:

https://boris.unibe.ch/id/eprint/145478

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