Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA - A prospective, multicenter study

Background and Purpose-Early admission to hospital followed by correct diag nosis with minimum delay is a prerequisite for successful intervention in a cute stroke. This study aimed at clarifying in detail the factors related t o these delays. Methods-This was a prospective, multicenter, consecutive study that explore d factors influencing the time from stroke or transient ischemic attack (TI A) onset until patient arrival at the emergency department, stroke unit, an d CT laboratory. Within 3 days of hospital admission, the patients and/or t heir relatives were interviewed by use of a standardized structured protoco l, and the patients' neurological deficits were assessed. No information ab out this study was given to the public or to the staff. Results-Patients (n = 329) were studied at 15 Swedish academic or community -based hospitals: 252 subjects with brain infarct, Is with intracerebral he morrhage, and 59 with TIA. Among stroke and TIA patients, the median times from onset to hospital admission, stroke unit, and CT scan laboratory were 4.8 and 4.0 hours, 8.8 and 7.5 hours, and 22.0 and 17.5 hours, respectively . From multivariate ANOVA with logarithmically transformed time for increas ing delay to hospital admission as the dependent variable, a profile of sig nificant risk factors was obtained. This included patients with a brain inf arct, gradual onset, mild neurological symptoms, patients who were alone an d did not contact anybody when symptoms occurred, patients who lived in a l arge catchment area, those who did not use ambulance transportation, and th ose who visited a primary care site. These factors explained 45.3% of the v ariance in delayed hospital admission. The median time from arrival at the emergency department to arrival at the stroke unit or CT scan laboratory (w hichever occurred first) was 2.6 and 2.7 hours in the stroke and TLA groups , respectively. A large catchment area, moderate to mild neurological defic it, and waiting for the physician at the emergency department were all sign ificantly related to in-hospital delay. Conclusions-Increased public awareness of the need to seek medical or other attention promptly after stroke onset, to use an ambulance with direct tra nsportation to the acute-care hospital, and to have more effective in-hospi tal organization will be required for effective acute treatment options to be available to stroke patients.