Factors associated with hospital arrival time in acute stroke

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND | 2019. Background: Acute stroke management is a time-dependent process, and early intervention is associated with more favorable outcomes. Given the time sensitivity of stroke management, the high morbidity and mortality rate, and the high cost of long-term post-stroke care, more information is needed about the factors that influence hospital arrival time after acute stroke in Thailand. Objective: To investigate the factors that significantly influence hospital arrival time after acute stroke. Materials and Methods: A retrospective chart review of acute stroke patients treated at the Division of Neurology, Department of Medicine, Siriraj Hospital, Bangkok, Thailand between 2007 and 2010 was conducted. Patients were allocated to either early (4.5 hours or less) or delayed (more than 4.5 hours) hospital arrival group. Demographic data, comorbidities, stroke severity using the NIHSS, current medications, mode of transportation to the hospital, referral status, and final diagnosis were collected. Results: Of 1,045 patients, mean age was 65.4±13.8 years, 46.0% were female, and the median NIHSS score was 6. Regarding arrival time, 40.2%, 51.6%, and 59.14% of patients arrived at the hospital within 3, 4.5, and 6 hours, respectively. Only 6.6% arrived by ambulance. Multivariate logistic regression analysis revealed previous ischemic stroke/transient ischemic attack (p=0.022), diagnosis of severe stroke (NIHSS score >15) (p=0.001), seizure as an initial symptom (p=0.023), and diagnosis of hemorrhagic stroke (p=0.004) to be associated with early hospital arrival. Awakening or unknown-onset stroke (p<0.001) and referral from other centers (p<0.001) were factors associated with late arrival. Conclusion: The factors that significantly influenced hospital arrival time after acute stroke in Thai population are the very low rate of EMS used and the delay in the referral of patients from other hospitals. Further study to investigate strategies to improve stroke awareness and referral protocols are warranted.