FACTORS DELAYING HOSPITAL ADMISSION IN ACUTE STROKE - THE COPENHAGEN STROKE STUDY

Medical treatment of stroke is dependent on a narrow therapeutic time window. We prospectively analyzed the influence of demographic, medica l, and pathophysiologic factors on admission delay in 1,197 unselected , acute stroke patients. Twenty five percent were admitted within 3 1/ 2 hours, 35% within 6 hours, 50% within 14 hours, and 68% within 24 ho urs after stroke onset. Living alone (odds ratio [OR] 1.75, 95% CI 1.3 to 2.3) and retired working status (OR 1.61, 95% CI 1.01 to 2.54) del ayed admission. A well-working social network thus seems important to early admission. The milder the stroke, the higher was the risk of del ayed admission (OR 1.25 per 10 points decrease in stroke severity [Sca ndinavian Neurological Stroke Scale score on admission], 95% CI 1.14 t o 1.3). A history of TIA increased the relative chance of early admiss ion by odds 1.64 (95% CI 1.06 to 2.54). Other factors such as age, sex , diabetes, hypertension, ischemic heart disease, other comorbidity, p revious stroke, headache, aphasia, apraxia, anosognosia, neglect, lowe red consciousness, mental status (Mini-Mental State Examination) and t ype of stroke (hemorrhage infarct) had no independent influence on adm ission time. Admission was markedly delayed in most patients. This rep resents a major barrier to medical treatment. Patients with the most s evere strokes are admitted early, but patients with milder symptoms sh ould also be encouraged to seek immediate admission. The observation t hat a history of TIA reduced admission time indicates that an increase in public awareness and knowledge may reduce delay and save precious time.