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Identification of high-risk factors for prehospital delay for patients with stroke using the risk matrix methods
Zihan Gao1, Qinqin Liu2, Li Yang1
1School of Nursing, Qingdao University, Qingdao, China.
Insights
Prehospital delay in acute ischemic stroke (AIS) is a major issue in China. Key factors include rural living, lack of bystanders, and poor understanding of stroke urgency and thrombolysis time windows.
Area of Science:
- Neurology
- Public Health
- Emergency Medicine
Background:
- Stroke is a leading cause of death and disability in China.
- Low thrombolytic treatment rates (2.5%) highlight challenges in acute ischemic stroke (AIS) management.
- Prehospital delay is a significant barrier to effective AIS treatment, with uncertain controllable risk factors.
Purpose of the Study:
- To develop a risk assessment tool for identifying critical prehospital delay factors in AIS patients.
- To provide insights for improving timely stroke care in China.
Main Methods:
- A study involving 450 AIS patients from November 2018 to July 2019.
- Utilized the Delphi technique for expert consensus on risk indices.
- Employed a risk matrix to pinpoint high-risk factors for prehospital delay.
Main Results:
- Five critical risk factors for prehospital delay were identified: rural residence, absence of bystanders, lack of understanding regarding stroke urgency, unawareness of thrombolysis necessity and time windows, and self-medication with delayed treatment seeking.
- These factors significantly contribute to delayed emergency medical services for AIS patients.
Conclusions:
- The developed risk assessment tool can aid in preventing prehospital delays for AIS patients.
- Addressing identified risk factors is crucial for improving outcomes in acute ischemic stroke care.
Background:
Stroke has become a leading cause of mortality and adult disability in China. The key to treating acute ischemic stroke (AIS) is to open the obstructed blood vessels as soon as possible and save the ischemic penumbra. However, the thrombolytic rate in China is only 2.5%. Research has been devoted to investigating the causes of prehospital delay, but the exact controllable risk factors for prehospital delay remain uncertain, and a consensus is lacking. We aimed to develop a risk assessment tool to identify the most critical risk factors for prehospital delay for AIS patients.
Methods:
From November 2018 to July 2019, 450 patients with AIS were recruited. Both qualitative and quantitative data were collected. The Delphi technique was used to obtain expert opinions about the importance of the risk indices in two rounds of Delphi consultation. Then, we used the risk matrix to identify high-risk factors for prehospital delay for AIS patients.
Results:
The risk matrix identified the following five critical risk factors that account for prehospital delay after AIS: living in a rural area; no bystanders when stroke occurs; patients and their families lacking an understanding of the urgency of stroke treatment; patients and their families not knowing that stroke requires thrombolysis or that there is a thrombolysis time window; and the patient self-medicating, unaware of the seriousness of the symptoms, and waiting for spontaneous remission.
Conclusions:
The risk analysis tool used during this study may help prevent prehospital delays for patients with AIS.
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