Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients
(1) Background: The benefit of acute ischemic stroke (AIS) treatment declines with any time delay until treatment. Hence, factors influencing the time from symptom onset to admission (TTA) are of utmost importance. This study aimed to assess temporal trends and risk factors for delays in TTA. (2) Me...
Main Authors: | , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
MDPI AG
2020-07-01
|
Series: | Journal of Clinical Medicine |
Subjects: | |
Online Access: | https://www.mdpi.com/2077-0383/9/8/2376 |
id |
doaj-43543e01f5244d10a526c0a1a99f42a0 |
---|---|
record_format |
Article |
spelling |
doaj-43543e01f5244d10a526c0a1a99f42a02020-11-25T03:51:39ZengMDPI AGJournal of Clinical Medicine2077-03832020-07-0192376237610.3390/jcm9082376Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke PatientsMoritz Kielkopf0Thomas Meinel1Johannes Kaesmacher2Urs Fischer3Marcel Arnold4Mirjam Heldner5David Seiffge6Pasquale Mordasini7Tomas Dobrocky8Eike Piechowiak9Jan Gralla10Simon Jung11Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandInstitute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric, Radiology and Department of Neurology, University Hospital Bern, Inselspital, University of Bern, 3010 Bern, SwitzerlandDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandUniversity Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandUniversity Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandUniversity Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandUniversity Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland(1) Background: The benefit of acute ischemic stroke (AIS) treatment declines with any time delay until treatment. Hence, factors influencing the time from symptom onset to admission (TTA) are of utmost importance. This study aimed to assess temporal trends and risk factors for delays in TTA. (2) Methods: We included 1244 consecutive patients from 2015 to 2018 with suspected stroke presenting within 24 h after symptom onset registered in our prospective, pre-specified hospital database. Temporal trends were assessed by comparing with a cohort of a previous study in 2006. Factors associated with TTA were assessed by univariable and multivariable regression analysis. (3) Results: In 1244 patients (median [IQR] age 73 [60–82] years; 44% women), the median TTA was 96 min (IQR 66–164). The prehospital time delay reduced by 27% in the last 12 years and the rate of patients referred by Emergency medical services (EMS) increased from 17% to 51% and the TTA for admissions by General Practitioner (GP) declined from 244 to 207 min. Factors associated with a delay in TTA were stroke severity (beta−1.9; 95% CI–3.6 to −0.2 min per point NIHSS score), referral by General Practitioner (GP, beta +140 min, 95% CI 100–179), self-admission (+92 min, 95% CI 57–128) as compared to admission by emergency medical services (EMS) and symptom onset during nighttime (+57 min, 95% CI 30–85). Conclusions: Although TTA improved markedly since 2006, our data indicates that continuous efforts are mandatory to raise public awareness on the importance of fast hospital referral in patients with suspected stroke by directly informing EMS, avoiding contact of a GP, and maintaining high effort for fast transportation also in patients with milder symptoms.https://www.mdpi.com/2077-0383/9/8/2376time to admissionprehospital delaystrokeprior stroke |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Moritz Kielkopf Thomas Meinel Johannes Kaesmacher Urs Fischer Marcel Arnold Mirjam Heldner David Seiffge Pasquale Mordasini Tomas Dobrocky Eike Piechowiak Jan Gralla Simon Jung |
spellingShingle |
Moritz Kielkopf Thomas Meinel Johannes Kaesmacher Urs Fischer Marcel Arnold Mirjam Heldner David Seiffge Pasquale Mordasini Tomas Dobrocky Eike Piechowiak Jan Gralla Simon Jung Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients Journal of Clinical Medicine time to admission prehospital delay stroke prior stroke |
author_facet |
Moritz Kielkopf Thomas Meinel Johannes Kaesmacher Urs Fischer Marcel Arnold Mirjam Heldner David Seiffge Pasquale Mordasini Tomas Dobrocky Eike Piechowiak Jan Gralla Simon Jung |
author_sort |
Moritz Kielkopf |
title |
Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients |
title_short |
Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients |
title_full |
Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients |
title_fullStr |
Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients |
title_full_unstemmed |
Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients |
title_sort |
temporal trends and risk factors for delayed hospital admission in suspected stroke patients |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2020-07-01 |
description |
(1) Background: The benefit of acute ischemic stroke (AIS) treatment declines with any time delay until treatment. Hence, factors influencing the time from symptom onset to admission (TTA) are of utmost importance. This study aimed to assess temporal trends and risk factors for delays in TTA. (2) Methods: We included 1244 consecutive patients from 2015 to 2018 with suspected stroke presenting within 24 h after symptom onset registered in our prospective, pre-specified hospital database. Temporal trends were assessed by comparing with a cohort of a previous study in 2006. Factors associated with TTA were assessed by univariable and multivariable regression analysis. (3) Results: In 1244 patients (median [IQR] age 73 [60–82] years; 44% women), the median TTA was 96 min (IQR 66–164). The prehospital time delay reduced by 27% in the last 12 years and the rate of patients referred by Emergency medical services (EMS) increased from 17% to 51% and the TTA for admissions by General Practitioner (GP) declined from 244 to 207 min. Factors associated with a delay in TTA were stroke severity (beta−1.9; 95% CI–3.6 to −0.2 min per point NIHSS score), referral by General Practitioner (GP, beta +140 min, 95% CI 100–179), self-admission (+92 min, 95% CI 57–128) as compared to admission by emergency medical services (EMS) and symptom onset during nighttime (+57 min, 95% CI 30–85). Conclusions: Although TTA improved markedly since 2006, our data indicates that continuous efforts are mandatory to raise public awareness on the importance of fast hospital referral in patients with suspected stroke by directly informing EMS, avoiding contact of a GP, and maintaining high effort for fast transportation also in patients with milder symptoms. |
topic |
time to admission prehospital delay stroke prior stroke |
url |
https://www.mdpi.com/2077-0383/9/8/2376 |
work_keys_str_mv |
AT moritzkielkopf temporaltrendsandriskfactorsfordelayedhospitaladmissioninsuspectedstrokepatients AT thomasmeinel temporaltrendsandriskfactorsfordelayedhospitaladmissioninsuspectedstrokepatients AT johanneskaesmacher temporaltrendsandriskfactorsfordelayedhospitaladmissioninsuspectedstrokepatients AT ursfischer temporaltrendsandriskfactorsfordelayedhospitaladmissioninsuspectedstrokepatients AT marcelarnold temporaltrendsandriskfactorsfordelayedhospitaladmissioninsuspectedstrokepatients AT mirjamheldner temporaltrendsandriskfactorsfordelayedhospitaladmissioninsuspectedstrokepatients AT davidseiffge temporaltrendsandriskfactorsfordelayedhospitaladmissioninsuspectedstrokepatients AT pasqualemordasini temporaltrendsandriskfactorsfordelayedhospitaladmissioninsuspectedstrokepatients AT tomasdobrocky temporaltrendsandriskfactorsfordelayedhospitaladmissioninsuspectedstrokepatients AT eikepiechowiak temporaltrendsandriskfactorsfordelayedhospitaladmissioninsuspectedstrokepatients AT jangralla temporaltrendsandriskfactorsfordelayedhospitaladmissioninsuspectedstrokepatients AT simonjung temporaltrendsandriskfactorsfordelayedhospitaladmissioninsuspectedstrokepatients |
_version_ |
1724486266202882048 |