Factors Influencing Prehospital and Inhospital Time Delays for Ischemic Stroke Patients

ABSTRACT

PURPOSE: This study was designed to investigate the time delay in the prehospital and inhospital course of acute ischemic stroke patients at an emergency department (ED). METHODS: We collected data from medical records retrospectively, including baseline characteristics, mode of arrival, arrival time, and neurological symptoms, from January 2006 to October 2008. Time data were also collected; from symptom onset to ED visit (prehospital delay), ED visit to brain imaging (imaging delay), and from ED visit to treatment (treatment delay). We designed multivariate Cox-regression models to predict factors influencing prehospital and ED time for ischemic stroke. RESULTS: In total, 946 ischemic stroke patients were enrolled. Diabetes mellitus was associated with a longer prehospital delay. Heart disease, hyperlipidemia, and use of an emergency medical service (EMS) were associated with a shorter prehospital delay. Female gender, night time visits, and abnormal speech were associated with a longer imaging delay. Hypertension, use of EMS, multiple symptoms, and prehospital delay within 3 hours were associated with a shorter delay. Abnormal speech was also a significant factor for a longer treatment delay. Tingling sense or numbness, multiple symptoms, and a prehospital delay within 3 hours were related to a shorter treatment delay. CONCLUSION: The time delay in the prehospital and ED course of acute ischemic stroke patients was associated with multiple factors including gender, comorbidities, use of EMS, arrival time, acute symptom onset within 3 hours, neurological symptoms, and multiple neurological symptoms.