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Published on: January 18, 2018
Pre-hospital Delay after Acute Ischemic Stroke in Central Urban China: Prevalence and Risk Factors
Yanfeng Zhou1, Tingting Yang1, Yanhong Gong1
1Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Insights
Pre-hospital delays are common for acute ischemic stroke (AIS) patients in urban China, with over half arriving 6+ hours after symptom onset. Interventions should target public awareness and prompt response to stroke symptoms.
Area of Science:
- Neurology
- Public Health
- Emergency Medicine
Background:
- Timely thrombolytic treatment is critical for acute ischemic stroke (AIS) outcomes.
- Significant pre-hospital delays in hospital presentation are a major barrier to effective AIS treatment.
- Understanding the prevalence and risk factors for these delays is essential for improving patient care in urban China.
Purpose of the Study:
- To evaluate the prevalence of pre-hospital delays in acute ischemic stroke patients in central urban China.
- To identify risk factors associated with substantial pre-hospital delays (≥3 hours and ≥6 hours) after AIS onset.
- To inform targeted interventions for reducing delays and improving treatment access.
Main Methods:
- Cross-sectional study involving 1835 AIS patients from 66 hospitals in 13 major cities in Hubei Province, China (October 2014 - January 2015).
- Data collection through patient interviews and medical record reviews.
- Bivariate and multivariate analyses were used to determine prevalence rates and identify risk factors for pre-hospital delays.
Main Results:
- A high prevalence of pre-hospital delays was observed: 69.3% of patients arrived ≥3 hours after onset, and 55.3% arrived ≥6 hours after onset.
- Factors associated with increased delays (≥3 hours) included a history of stroke, symptom onset at home, and patients noticing symptoms themselves.
- Factors associated with decreased delays included prior knowledge of stroke, perceiving symptoms as severe, transfer from community hospitals, calling emergency services (120), and shorter travel distance.
Conclusions:
- Pre-hospital delays are a significant issue for acute ischemic stroke patients in urban central China.
- Patient-related factors (history of stroke, self-awareness of symptoms) and logistical factors (onset location, transport) influence delay times.
- Future interventions should focus on enhancing public awareness of stroke symptoms and promoting timely, appropriate emergency responses.
Abstract:
Timely thrombolytic treatment is paramount after acute ischemic stroke (AIS); however, a large proportion of patients experience substantial delays in presentation to hospital. This study evaluates the prevalence and risk factors in pre-hospital delays after AIS in central urban China. AIS patients from 66 hospitals in 13 major cities across Hubei Province, between October 1, 2014 and January 31, 2015 were interviewed and their medical records were reviewed to identify those who suffered pre-hospital delays. Bivariate and multivariate analyses were undertaken to determine the prevalence rates and the risk factors associated with pre-hospital delays. A total of 1835 patients were included in the analysis, with 69.3 % patients reportedly arrived at hospital 3 or more hours after onset and 55.3 % patients arrived 6 or more hours after onset. Factors associated with increased pre-hospital delays for 3 or more hours were as follows: patient had a history of stroke (odds ratio (OR), 1.319, P = 0.028), onset location was at home (OR, 1.573, P = 0.002), and patients rather than someone else noticed the symptom onset first (OR, 1.711; P < 0.001). In contrast, knowing someone who had suffered a stroke, considering any kind of the symptoms as severe, transferring from a community-based hospital factors, calling emergency number (120), and shorter distance from the onset place to the first hospital were independently associated with decreased pre-hospital delays. These findings indicate that pre-hospital delays after AIS are common in urban central China, and future intervention programs should be focused on public awareness of stroke and appropriate response.
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