Factors delaying hospital arrival of patients with acute stroke.
Factors delaying hospital arrival of patients with acute stroke.
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DOI：
10.4103/0972-2327.150627
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发表时间：
2008-04-01
期刊：
影响因子：
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通讯作者：
Khan, Farrukh Shohab
中科院分区：
文献类型：
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作者：
Siddiqui, Maimoona;Siddiqui, Shoaib Rasheed;Khan, Farrukh Shohab
背景技术背景：在印度和其他发展中国家的缺血性卒中溶栓率低已被归因于延迟提交hospital.MATERIALS和METHODS：一项前瞻性研究进行了为期12个月的期间，截至2012年12月在神经病学，马拉巴尔医学科学研究所，喀拉拉邦，印度，寻找急性卒中患者延迟到达医院的因素。患者和/或他们的亲属在入院后48小时内进行了采访，使用结构式questionnaire.Results：共264例急诊科就诊的患者。其中男性170人，女性94人。平均年龄为61.5 ± 12.4岁。共有67例（25%）患者在卒中发作后4小时内就诊。提前到达的相关因素多因素Logistic回归分析显示，距医院15 km或更短（P0.03，比值比（OR）2.7），直达卒中科（P < 0.001，OR9.7），冠心病史（P 0.001，OR 3.84）、较高的教育程度（P 0.001，OR 3.7）和存在偏瘫（P 0.001，OR 5.5）。结论：我们发现患者早期到达我们的卒中科有相当大的延迟。提高社区对卒中早期症状的认识的健康促进策略、教育当地医生早期转诊至卒中中心的重要性以及更广泛地提供和使用救护车服务是有希望的方法，有助于加快卒中后到医院就诊，从而改善印度卒中的管理。确定急性脑卒中患者延迟到医院的比例，并确定延迟急性脑卒中患者到达医院的因素。2006年9月至2007年2月在卡拉奇利亚卡特国立医院神经内科进行了一项横断面研究。所有患者的性别，年龄>18岁，有中风症状和神经影像学（CT扫描/MRI脑）结果与中风一致，包括在内。男性86例（52%），女性79例（47.9%）。平均年龄为60.04 ± 13.98岁（男性58.2岁，女性61.9岁）。从出现症状到到达医院的平均延迟时间为6小时。3小时内就诊者仅占28.5%，3小时后就诊者占71.5%。47例患者的护理人员有低喉感，53例（32%）患者不知道卒中的单一症状，63%（104例）患者首先联系了他们的全科医生，由他们将他们转诊到医院。同样，60.6%的患者穿第一次采取了当地医院没有配备处理重大emergency.CONCLUSION：从症状发作到医院到达的时间是影响缺乏知识的中风症状，接触当地医生，低威胁的感知和救护车服务的不可用性。
BACKGROUND: Low rates of thrombolysis for ischemic stroke in India and other developing countries have been attributed to delays in presentation to the hospital.MATERIALS AND METHODS: A prospective study was carried out during a 12-month period ending December 2012 in the department of Neurology, Malabar Institute of Medical Sciences, Kerala, India, to look for the factors contributing to delay in hospital arrival of patients with acute stroke. Patients and or their relatives were interviewed within 48 hours of admission using a structured questionnaire.RESULTS: A total of 264 patients attending the emergency department were included. There were 170 men and 94 women. The mean age was 61.5 ± 12.4 years. A total of 67 (25%) patients presented within 4 hours of stroke onset. Factors associated with early arrival (multivariate logistic regression analysis) were distance 15 km or less from hospital (P 0.03, odds ratio (OR) 2.7), directly reaching the stroke department (P < 0.001, OR 9.7), history of coronary artery disease (P 0.001, OR 3.84), higher educational status (P 0.001, OR 3.7), and presence of hemiplegia (P 0.001, OR 5.5).CONCLUSIONS: We found a considerable delay in the early arrival of patients to our stroke department. Health promotion strategies to improve community awareness of early symptoms of stroke, education of local physicians about the importance of early referrals to the stroke centers, and wider availability and use of ambulance services are promising methods to help expedite presentation to hospital post stroke and thereby improve the management of stroke in India.INTRODUCTION: To determine the proportion of patients with acute stroke presenting late to hospital and to identify the factors that delay hospital arrival of patients with acute stroke.METHODS: A cross sectional study was carried out between Sept 2006 to Feb 2007 in the department of Neurology, Liaquat National Hospital Karachi. All patients of both genders, ago >18 years with symptoms of stroke and neuro- imaging (CT scan/MRI brain) findings consistent with stroke were included.RESULTS: Atotal of 165 patients attending the Emergency department were included. There were 86 (52%) males and 79 (47.9%) females. The mean age was 60.04+/-13.98 years, (males 58.2 years and females 61.9 years). The median delay from onset of symptoms to hospital arrival was six hours. Only 28.5% of the patients came within three hours while 71.5% after three hours. Attendants of 47 patients had a low throat perception, 53 (32%) of the patients did not know a single symptom of stroke and 63% (104) patients first contacted their General Practitioner who referred them to hospital. Similarly 60.6% of patients wore first taken to a local hospital not equipped to handle major emergencies.CONCLUSION: Time elapsed from onset of symptoms to hospital arrival is influenced by lack of knowledge of stroke symptoms, contact with a local doctor, low threat perception and non availability of ambulance services.