Identification and analysis of key risk factors for prehospital delay in patients with stroke.

BACKGROUND: Although recent advances have been made in the treatment of acute stroke, only a few patients have received reperfusion therapy. Studies on prehospital delay in patients with stroke have revealed a wide range of associated factors in different countries. However, a unified risk management system for stroke remains unavailable. There are no published risk management systems to manage prehospital delay in stroke patients across China. AIM: This study aimed to identify key risk factors that affect the prehospital delay risk prediction of acute ischemic stroke (AIS) patients and develop a crux of recommendations using the identified risk factors. METHODS: Prehospital delay predictors were collected through literature and expert interviews. We also developed a risk assessment questionnaire via two rounds of expert inquiry. From October 2017 to July 2019, 447 patients admitted for AIS and 202 relevant medical personnel from the Heilongjiang province of China were recruited. The risk factors were analyzed using the Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS) to extract those that significantly impacted prehospital delay. RESULTS: A total of seven key risk factors were extracted from the 22 factors that were evaluated. Of these factors, five were associated with the patient delay stage and two with the transportation delay stage. CONCLUSIONS: A multi-dimensional and whole-process risk management mechanism should be established for AIS patients. These patients should be advised to improve their risk coping ability and relevant departments should formulate complete medical treatment procedures and medical systems to ameliorate prehospital delay effectively.