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Reasons for prehospital delay in acute ischemic stroke

Fladt, Joachim and Meier, Nicole and Thilemann, Sebastian and Polymeris, Alexandros and Traenka, Christopher and Seiffge, David J. and Sutter, Raoul and Peters, Nils and Gensicke, Henrik and Flückiger, Benjamin and de Hoogh, Kees and Künzli, Nino and Bringolf-Isler, Bettina and Bonati, Leo H. and Engelter, Stefan T. and Lyrer, Philippe A. and De Marchis, Gian Marco. (2019) Reasons for prehospital delay in acute ischemic stroke. Journal of the American Heart Association, 8 (20). e013101.

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Abstract

Background Prehospital delay reduces the proportion of patients with stroke treated with recanalization therapies. We aimed to identify novel and modifiable risk factors for prehospital delay. Methods and Results We included patients with an ischemic stroke confirmed by diffusion-weighted magnetic resonance imaging, symptom onset within 24 hours and hospitalized in the Stroke Center of the University Hospital Basel, Switzerland. Trained study nurses interviewed patients and proxies along a standardized questionnaire. Prehospital delay was defined as >4.5 hours between stroke onset-or time point of wake-up-and admission. Overall, 336 patients were enrolled. Prehospital delay was observed in 140 patients (42%). The first healthcare professionals to be alarmed were family doctors for 29% of patients (97/336), and a quarter of these patients had a baseline National Institute of Health Stroke Scale score of 4 or higher. The main modifiable risk factor for prehospital delay was a face-to-face visit to the family doctor (adjusted odds ratio, 4.19; 95% CI, 1.85-9.46). Despite transport by emergency medical services being associated with less prehospital delay (adjusted odds ratio, 0.41; 95% CI, 0.24-0.71), a minority of patients (39%) who first called their family doctor were transported by emergency medical services to the hospital. The second risk factor was lack of awareness of stroke symptoms (adjusted odds ratio, 4.14; 95% CI, 2.36-7.24). Conclusions Almost 1 in 3 patients with a diffusion-weighted magnetic resonance imaging-confirmed ischemic stroke first called the family doctor practice. Face-to-face visits to the family doctor quadrupled the odds of prehospital delay. Efforts to reduce prehospital delay should address family doctors and their staffs as important partners in the prehospital pathway. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02798770.
Faculties and Departments:03 Faculty of Medicine
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik)
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Intensivmedizin > Intensivmedizin (Marsch)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Intensivmedizin > Intensivmedizin (Marsch)
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Neurologie
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Neurologie
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Chronic Disease Epidemiology > Air Pollution and Health (Künzli)
03 Faculty of Medicine > Departement Public Health > Sozial- und Präventivmedizin > Air Pollution and Health (Künzli)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Environmental Exposures and Health > Physical Hazards and Health (Röösli)
UniBasel Contributors:Sutter, Raoul Christian and Flückiger, Benjamin and de Hoogh, Kees and Künzli, Nino and Bringolf, Bettina
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Association
ISSN:2047-9980
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
Identification Number:
Last Modified:10 Oct 2019 07:15
Deposited On:10 Oct 2019 07:15

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