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Article

Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients

1
Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
2
Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric, Radiology and Department of Neurology, University Hospital Bern, Inselspital, University of Bern, 3010 Bern, Switzerland
3
University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(8), 2376; https://doi.org/10.3390/jcm9082376
Received: 20 June 2020 / Revised: 20 July 2020 / Accepted: 22 July 2020 / Published: 25 July 2020
(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)
(1) Background: The benefit of acute ischemic stroke (AIS) treatment declines with any time delay until treatment. Hence, factors influencing the time from symptom onset to admission (TTA) are of utmost importance. This study aimed to assess temporal trends and risk factors for delays in TTA. (2) Methods: We included 1244 consecutive patients from 2015 to 2018 with suspected stroke presenting within 24 h after symptom onset registered in our prospective, pre-specified hospital database. Temporal trends were assessed by comparing with a cohort of a previous study in 2006. Factors associated with TTA were assessed by univariable and multivariable regression analysis. (3) Results: In 1244 patients (median [IQR] age 73 [60–82] years; 44% women), the median TTA was 96 min (IQR 66–164). The prehospital time delay reduced by 27% in the last 12 years and the rate of patients referred by Emergency medical services (EMS) increased from 17% to 51% and the TTA for admissions by General Practitioner (GP) declined from 244 to 207 min. Factors associated with a delay in TTA were stroke severity (beta−1.9; 95% CI–3.6 to −0.2 min per point NIHSS score), referral by General Practitioner (GP, beta +140 min, 95% CI 100–179), self-admission (+92 min, 95% CI 57–128) as compared to admission by emergency medical services (EMS) and symptom onset during nighttime (+57 min, 95% CI 30–85). Conclusions: Although TTA improved markedly since 2006, our data indicates that continuous efforts are mandatory to raise public awareness on the importance of fast hospital referral in patients with suspected stroke by directly informing EMS, avoiding contact of a GP, and maintaining high effort for fast transportation also in patients with milder symptoms. View Full-Text
Keywords: time to admission; prehospital delay; stroke; prior stroke time to admission; prehospital delay; stroke; prior stroke
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MDPI and ACS Style

Kielkopf, M.; Meinel, T.; Kaesmacher, J.; Fischer, U.; Arnold, M.; Heldner, M.; Seiffge, D.; Mordasini, P.; Dobrocky, T.; Piechowiak, E.; Gralla, J.; Jung, S. Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients. J. Clin. Med. 2020, 9, 2376. https://doi.org/10.3390/jcm9082376

AMA Style

Kielkopf M, Meinel T, Kaesmacher J, Fischer U, Arnold M, Heldner M, Seiffge D, Mordasini P, Dobrocky T, Piechowiak E, Gralla J, Jung S. Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients. Journal of Clinical Medicine. 2020; 9(8):2376. https://doi.org/10.3390/jcm9082376

Chicago/Turabian Style

Kielkopf, Moritz, Thomas Meinel, Johannes Kaesmacher, Urs Fischer, Marcel Arnold, Mirjam Heldner, David Seiffge, Pasquale Mordasini, Tomas Dobrocky, Eike Piechowiak, Jan Gralla, and Simon Jung. 2020. "Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients" Journal of Clinical Medicine 9, no. 8: 2376. https://doi.org/10.3390/jcm9082376

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