Time to hospital admission for acute stroke: an observational study

To determine the time from symptom onset to hospital admission of patients with suspected acute stroke, final diagnoses and patient eligibility for thrombolytic therapy.

Hospital-based, prospective, observational study.

Royal Adelaide Hospital Stroke Unit, South Australia.

All patients admitted to the unit with suspected acute stroke over 11 months (11 April to 10 October 2000 and 20 August 2001 to 19 January 2002).

Time from symptom onset to admission; final diagnosis.

Of 284 patients admitted, 39 (14%) had diagnoses other than stroke (including eight with transient ischaemic attacks), 42 (15%) had haemorrhagic stroke and 203 (71%) had ischaemic stroke. Median time to admission after symptom onset was 6 hours (range, 30 min to 13 days), with 100 patients admitted within 3 hours of symptom onset (35%), and 80 within 2 hours (28%). Thirty-seven patients (13%) could have been considered for thrombolysis (diagnosis of non-severe but disabling ischaemic stroke and admission time < 3 hours). Location at stroke onset was the only independent predictor of time to admission.

Most patients with stroke do not present urgently to the emergency department, rendering them less likely to be considered for thrombolytic therapy.