Temporal trend and factors associated with delayed hospital admission of stroke patients

The effectiveness of stroke treatment depends on the time interval between onset of symptoms and admission to hospital. The purpose of our investigati on was to assess, over a 10-year period, the mean delay in admission to hos pital in stroke patients to determine factors which might be associated wit h this delay, to define the putative number of patients available for accru al in clinical trials, and to identify strategies aimed at decreasing the t ime to admission. We collected data on all stroke patients consecutively ad mitted to our clinic from 1986 to 1995. The following variables were invest igated: age, sex, educational and occupational level, home accommodation, f amily and personal history of vascular disease or factors known to affect t he risk of vascular disease, and type and severity of stroke. The individua l and independent contribution of these variables was assessed by univariat e and multivariate analysis. The accurate time of stroke onset was establis hed for 760 patients. Of these, 24.7% were admitted within 1 h from the ons et of symptoms, 41% within 2 h, 54% within 4 h and 72.5% within 12 h. The m ean delay was 21 +/- 2 h (SE) and the median was 3.5 h. Acute onset of neur ological deficits, stroke severity and family history of cerebrovascular di sease were associated with earlier presentation. According to the current g uidelines for thrombolytic therapy, only 16% of the patients could have bee n included in a clinical trial. This study suggests that despite a relative ly short time to hospital admission in most patients and an altered help-se eking behavior over time, many stroke patients did not present early enough to be recruited for clinical trials or to benefit from new treatments. The majority of patients with timely presentation were not eligible for acute treatment, or were subjects with severe stroke for whom caution is advised before initiating thrombolytic therapy. It has been suggested that the pati ent's indecision to seek medical help is the most important reason for a de layed hospital admission of stroke patients. These results underscore the i mportance of interventions aimed at reducing the delay in stroke treatment induced by patients who are unaware of the decisive role of the time of tre atment induction. The finding that earliest admissions for stroke comprised patients with a previous history of cerebrovascular disease suggests that an education campaign might highlight the importance of an early admission.