Factors influencing emergency delays in acute stroke management

Article Article scientifique Article Factors influencing emergency delays in acute stroke management eng 2009 author Sekoranja Lucka 504644 author Griesser-delacretaz Anne-Claude 83214 author Wagner Ghislaine author Njamnshi Alfred Kongnyu 43666 author Temperli Philippe 590480 author Herrmann François 70980 author Grandjean Raphael Olivier Pierre 97332 author Niquille Marc 527068 author Vermeulen Bernard 133725 author Rutschmann Olivier Thierry 45545 author Sarasin François 65003 author Sztajzel Roman 30504 393-399 10.4414/smw.2009.12506 19629767 0036-7672 OBJECTIVE: Early admission to hospital with minimum delay is a prerequisite for successful management of acute stroke. We sought to determine our local pre- and in-hospital factors influencing this delay. PATIENTS AND METHODS: Time from onset of symptoms to admission (admission time) was prospectively documented during a 6-month period (December 2004 to May 2005) in patients consecutively admitted for an acute focal neurological deficit presented at arrival and of presumed vascular origin. Mode of transportation, patient's knowledge and correct recognition of stroke symptoms were assessed. Physicians contacted by the patients or their relatives were interviewed. The influence of referral patterns on in-hospital delays was further evaluated. RESULTS: Overall, 331 patients were included, 249 had an ischaemic and 37 a haemorrhagic stroke. Forty-five patients had a TIA with neurological symptoms subsiding within the first hours after admission. Median admission time was 3 hours 20 minutes. Transportation by ambulance significantly shortened admission delays in comparison with the patient's own means (HR 2.4, 95% CI 1.6-3.7). The only other factor associated with reduced delays was awareness of stroke (HR 1.9, 95% CI 1.3-2.9). Early in-hospital delays, specifically time to request CT-scan and time to call the neurologist, were shorter when the patient was referred by his family or to a lesser extent by an emergency physician than by the family physician (p < 0.04 and p < 0.01, respectively) and were shorter when he was transported by ambulance than by his own means (p < 0.01). CONCLUSIONS: Transportation by ambulance and referral by the patient or family significantly improved admission delays and early in-hospital management. Correct recognition of stroke symptoms further contributed to significant shortening of admission time. Educational programmes should take these findings into account. Acute Disease Aged *Emergencies Female Humans Male *Patient Admission Physicians Questionnaires Referral and Consultation Stroke/*therapy Time Factors Transportation of Patients Dewey 613 Dewey 616.8 Dewey 618.97 Dewey 617 57 Département de chirurgie 222 61 Département des neurosciences cliniques 226 64 Département de santé et médecine communautaires 22A 65 Département de réadaptation et gériatrie 22B false 17 Médecine d'urgence 24 Schweizerische medizinische Wochenschrift 139 27-28 056ef8e6-1589-4819-b7ed-7aeee23fe303 Article Public file1.pdf 263791 application/pdf openAccess Faculté de médecine / Section de médecine clinique / Département de chirurgie Faculté de médecine / Section de médecine clinique / Département des neurosciences cliniques Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires Faculté de médecine / Section de médecine clinique / Département de réadaptation et gériatrie

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Factors influencing emergency delays in acute stroke management	Schweizerische medizinische Wochenschrift			2009	699	340

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Temperli, Philippe