Prehospital and in-hospital delays in acute stroke care

Current guidelines emphasize the need for early stroke care. However, signi ficant delays occur during both the prehospital and in-hospital phases of c are, making many patients ineligible for stroke therapies. The purpose of t his study was to systematically review and summarize the existing scientifi c literature reporting prehospital and in-hospital stroke delay times in or der to assist future delivery of effective interventions to reduce delay ti me and to raise several key issues which future studies should consider. A comprehensive search was per formed to find all published journal articles which reported on the prehospital or in-hospital delay time for stroke, inc luding intervention studies. Since 1981, at least 48 unique reports of preh ospital delay time for patients with stroke, transient ischemic attack, or strokelike symptoms were published from 17 different countries. In the majo rity of studies which reported median delay times, the median time from sym ptom onset to arrival in the emergency department was between 3 and 6 h. Th e in-hospital times from emergency department arrival to being seen by an e mergency department physician, initiation and interpretation of a computed tomography (CT) scan, and being seen by a neurologist were consistently lon ger than recommended. However, prehospital delay comprised the majority of time from symptom onset to potential treatment. Definitions and methodologi es differed across studies, making direct comparisons difficult. This revie w suggests that the majority of stroke patients are unlikely to arrive at t he emergency department and receive a diagnostic evaluation in under 3 h. F urther studies of stroke delay and corresponding interventions are needed, with careful attention to definitions and methodologies. Copyright (C) 2001 S. Karger AG, Basel.