Prehospital delay and emergency department management of ischemic stroke patients in taiwan, r.o.c.

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Abstract
Objective. To determine the magnitude of prehospital delay and how much time elapses between emergency department (ED) presentation and ED clinical investigations in ischemic stroke patients. Factors associated with prehospital delay were also correlated with demographic characteristics and clinical variables. Methods. A prospective, observational study was conducted simultaneously in five community teaching hospitals in Taiwan from October 1997 to April 1998. Included were all patients presenting with acute ischemic stroke. In each case, diagnosis was confirmed by cranial CT scanning. The main outcomes measured were the number of patients presenting at the ED more than two hours after the onset of symptoms (Tprehospital > 2 hr) and the time spent at the ED for ED physician evaluation, cranial CT scanning, laboratory examinations, and neurologic consultation. Chi-square testing was used to compare the characteristics of patients with Tprehospital > 2 hr. and those with Tprehospital ≤ 2 hr. Independent predictors of Tprehospital > 2 hr were determined using multiple logistic regression. Results. Of 157 patients observed, 105 (67%) arrived at the hospital more than 2 hr after the onset of symptoms. Average time from ED presentation to examination by ED physician, completion of CT scanning, and laboratory investigations was 3, 58, and 61 minutes, respectively. Mean time from ED presentation to neurologic consultation was 174 minutes for 38 patients [24%, (38/157)1. The factor associated with Tprehospital > 2 hr was interhospital transfer (p < 0.05). Conclusion. This study reveals that delayed management of stroke patients is mainly due to delayed ED presentation and to difficulties in obtaining neurologic consultation. Ideally, a stroke center may be incorporated within the EMS system to overcome delays due to interhospital transfer and to difficulties in obtaining neurologic consultation.