Treatment Delays and Chance of Reperfusion Therapy in Patients with Acute Stroke : A Danish Nationwide Study
© 2022 S. Karger AG, Basel..
INTRODUCTION: We aimed to determine the treatment delay for ischemic stroke patients in Denmark.
METHODS: A nationwide register-based study on acute ischemic stroke patients admitted through emergency medical services. Treatment delay comprised patient, prehospital, and in-hospital delay. Analyses were stratified according to length of prehospital delay (<3 vs. ≥3 h).
RESULTS: A total of 5,356 ischemic stroke episodes were included. The median onset-to-door time was 187 min, and 2,405 (43%) arrived at the stroke unit within 3 h. Overall, the median patient delay was 115 min. For early arrival (n = 2,280), patient delay was 27 min compared to 437 min for late arrivals (n = 2,448). Median prehospital delay varied by 9 min between early- and late-arriving patients. Approximately 48% of the early-arriving patients compared to 9% of the late-arriving patients received i.v. thrombolysis. For thrombectomy, the numbers were 10% and 3%, respectively. This corresponded to an unadjusted relative risk (RR) of 0.18 (95% CI: 0.16-0.21) and adjusted (age, sex, cohabitation status, and stroke severity) RR of 0.20 (95% CI: 0.18-0.23) for i.v. thrombolysis when comparing patients arriving later than 3 h with patients arriving earlier. For thrombectomy, the unadjusted and adjusted RRs were 0.30 (95% CI: 0.23-0.39) and 0.40 (95% CI: 0.31-0.52), respectively.
CONCLUSIONS: Patient delay remains the most important barrier for use of reperfusion therapy among acute ischemic stroke patients calling 1-1-2, whereas system delay seems independent of patient delay.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:52 |
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| Enthalten in: |
Cerebrovascular diseases (Basel, Switzerland) - 52(2023), 3 vom: 31., Seite 275-282 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Mainz, Jeppe [VerfasserIn] |
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| Links: |
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| Themen: |
Emergency medical services |
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| Anmerkungen: |
Date Completed 01.06.2023 Date Revised 22.06.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1159/000526733 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM34830062X |
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| 500 | |a Date Completed 01.06.2023 | ||
| 500 | |a Date Revised 22.06.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 S. Karger AG, Basel. | ||
| 520 | |a INTRODUCTION: We aimed to determine the treatment delay for ischemic stroke patients in Denmark | ||
| 520 | |a METHODS: A nationwide register-based study on acute ischemic stroke patients admitted through emergency medical services. Treatment delay comprised patient, prehospital, and in-hospital delay. Analyses were stratified according to length of prehospital delay (<3 vs. ≥3 h) | ||
| 520 | |a RESULTS: A total of 5,356 ischemic stroke episodes were included. The median onset-to-door time was 187 min, and 2,405 (43%) arrived at the stroke unit within 3 h. Overall, the median patient delay was 115 min. For early arrival (n = 2,280), patient delay was 27 min compared to 437 min for late arrivals (n = 2,448). Median prehospital delay varied by 9 min between early- and late-arriving patients. Approximately 48% of the early-arriving patients compared to 9% of the late-arriving patients received i.v. thrombolysis. For thrombectomy, the numbers were 10% and 3%, respectively. This corresponded to an unadjusted relative risk (RR) of 0.18 (95% CI: 0.16-0.21) and adjusted (age, sex, cohabitation status, and stroke severity) RR of 0.20 (95% CI: 0.18-0.23) for i.v. thrombolysis when comparing patients arriving later than 3 h with patients arriving earlier. For thrombectomy, the unadjusted and adjusted RRs were 0.30 (95% CI: 0.23-0.39) and 0.40 (95% CI: 0.31-0.52), respectively | ||
| 520 | |a CONCLUSIONS: Patient delay remains the most important barrier for use of reperfusion therapy among acute ischemic stroke patients calling 1-1-2, whereas system delay seems independent of patient delay | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Emergency medical services | |
| 650 | 4 | |a Onset to treatment | |
| 650 | 4 | |a Stroke | |
| 650 | 4 | |a Thrombectomy | |
| 650 | 4 | |a Thrombolytic therapy | |
| 650 | 4 | |a Time factors | |
| 650 | 4 | |a Time to treatment | |
| 700 | 1 | |a Andersen, Grethe |e verfasserin |4 aut | |
| 700 | 1 | |a Valentin, Jan Brink |e verfasserin |4 aut | |
| 700 | 1 | |a Gude, Martin Faurholdt |e verfasserin |4 aut | |
| 700 | 1 | |a Johnsen, Søren Paaske |e verfasserin |4 aut | |
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