Prehospital delay after acute stroke in Klaipeda, Lithuania

Abstract

Objective. This study was designed to analyse the variables that influence the time fromsymptom onset to hospital admission. Methods. We prospectively examined acute stroke patients consecutively admitted toStroke unit of Klaipeda Hospital in the period between January 1st 2004 and December31st 2005. Demographic and neurological details, stroke syndromes, etiology, and time from symptom onset to the arrival at SU were recorded. A total of 823 patients were observed. For analysing the time variables, patients were dichotomised into those admitted within 3 hours (the current time window for thrombolytic therapy) and >3 hours. Logistic regression was used to analyse the factors associated with prehospital delay. Results. A total of 43.3% of our patients arrived within 3 hours and an additional 10.1%within 3 to 6 hours, and 62.7% within 12 hours. Direct admission by EMS (73.1% ofpatients) was associated with earlier arrival at the SU compared with other ways ofadmission. Patients with carotid territory strokes, either of right or left hemisphere, arrived earlier than patients with vertebrobasilar ischemia (OR=1.3; 95% CI 1.2-2.1). The hemorrhagic stroke patients arrived earlier than ischemic stroke patients (OR=1.6;1.1-2.4). A history of TIA were associated with longer delays (OR=0.3;0.5-0.9). Age, sex did notappear to affect delay time. Severe neurological symptoms associated with shorter delayincluded presence of limb weakness (OR=2.5;1.8-3.3), consciousness disturbance (OR=1.6;1.2-2.1), and balance dysfunction (OR=2.6;1.9-3.5). Conclusion. This study strongly suggests that the use of EMS is an important modifiable determinant of delay time for the treatment of acute stroke.