Factors Associated with Shortening of Prehospital Delay among Patients with Acute Ischemic Stroke
Factors Associated with Shortening of Prehospital Delay among Patients with Acute Ischemic Stroke
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DOI：
10.3390/jcm8101712
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发表时间：
2019-10-01
影响因子：
3.9
通讯作者：
Trejo-Gabriel-Galan, Jose M.
中科院分区：
文献类型：
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作者：
Soto-Camara, Raul;Gonzalez-Santos, Josefa;Trejo-Gabriel-Galan, Jose M.
背景资料：尽管最近在急性卒中护理方面取得了进展，但只有1-8%的患者可以接受再灌注治疗，这主要是因为院前延迟（PHD）。目的：本研究旨在确定从急性卒中症状发作到到达医院与PHD相关的因素。研究方法：进行了一项横断面研究，包括连续入住布尔戈斯大学医院（布尔戈斯，西班牙）的所有患者的中风症状。记录了社会人口统计学、临床、行为、认知和背景特征，并使用单变量和多变量回归分析研究了其与PHD的可能关联。结果如下：322例患者的中位PHD为138.50 min。以下因素缩短了PHD和再灌注治疗前的时间（如适用）：症状发作后立即寻求帮助（OR 10.36; 95%置信区间（CI）4.47-23.99），白天发生卒中（OR 7.73; 95% CI 3.09-19.34）和周末（OR 2.64; 95% CI 1.19-5.85），在家庭以外发生卒中（OR 7.09; 95% CI 1.97-25.55），使用预先通知系统（OR 6.46; 95% CI 1.71-8.39），患者认为在没有帮助的情况下无法控制症状（OR 5.14; 95% CI 2.60-10.16），既往知晓卒中为医学急诊（OR 3.20; 95% CI 1.38-7.40），呼叫紧急医疗服务作为第一医疗联系人（OR 2.77; 95% CI 1.32-5.88），患者经历的言语/语言困难（OR 2.21; 95% CI 1.16-4.36），以及患者对卒中症状的识别（OR 1.98; 95% CI 1.03-3.82）。结论：症状发作和到达医院之间的时间间隔取决于某些背景，认知和行为因素，所有这些都应该在规划未来的公众意识活动时加以考虑。
Background: Despite recent advances in acute stroke care, only 1-8% of patients can receive reperfusion therapies, mainly because of prehospital delay (PHD). Objective: This study aimed to identify factors associated with PHD from the onset of acute stroke symptoms until arrival at the hospital. Methods: A cross-sectional study was conducted including all patients consecutively admitted with stroke symptoms to Burgos University Hospital (Burgos, Spain). Socio-demographic, clinical, behavioral, cognitive, and contextualized characteristics were recorded, and their possible associations with PHD were studied using univariate and multivariable regression analyses. Results: The median PHD of 322 patients was 138.50 min. The following factors decreased the PHD and time until reperfusion treatment where applicable: asking for help immediately after the onset of symptoms (OR 10.36; 95% confidence interval (CI) 4.47-23.99), onset of stroke during the daytime (OR 7.73; 95% CI 3.09-19.34) and the weekend (OR 2.64; 95% CI 1.19-5.85), occurrence of stroke outside the home (OR 7.09; 95% CI 1.97-25.55), using a prenotification system (OR 6.46; 95% CI 1.71-8.39), patient's perception of being unable to control symptoms without assistance (OR 5.14; 95% CI 2.60-10.16), previous knowledge of stroke as a medical emergency (OR 3.20; 95% CI 1.38-7.40), call to emergency medical services as the first medical contact (OR 2.77; 95% CI 1.32-5.88), speech/language difficulties experienced by the patient (OR 2.21; 95% CI 1.16-4.36), and the identification of stroke symptoms by the patient (OR 1.98; 95% CI 1.03-3.82). Conclusions: The interval between the onset of symptoms and arrival at the hospital depends on certain contextual, cognitive, and behavioral factors, all of which should be considered when planning future public awareness campaigns.