Patient Delay and Ischemic Stroke Prognosis: A Systematic Review and Meta-Analysis

The influence of patient delay on prognosis in patients with ischemic stroke remains unclear. We conducted a systematic review and meta-analysis to determine the association of patient delay with the prognostic outcome of ischemic stroke. PubMed, Web of Science, Embase, Cochrane Library, CNKI, CBM, Wanfang Database, and VIP Database were comprehensively searched from inception to July 24, 2022. All case-control studies, cohort studies, and randomized controlled trials that met the inclusion criteria were retrieved; additionally, manual retrieval and literature tracing were performed. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias in the included studies. Revman 5.3.5 software was used for meta-analysis. We included 14 studies (11 cohort studies and 3 case-control studies) involving 25,337 patients. The results of meta-analysis revealed that the delayed visit group of patients with ischemic stroke had a higher mortality rate, readmission rate, stroke recurrence rate, and adverse outcomes rate than the timely visit group. Among them, mortality (OR = 2.03, 95% CI [1.13, 3.65], p = .02), readmission (OR = 8.17, [4.70, 14.21], p < .001), stroke recurrence rate (OR = 2.66, [1.51, 4.69], p < .001), and adverse outcomes rate (OR = 2.07, [1.18, 3.61], p < .001), respectively. There was no statistical difference in the National Institute of Health Stroke Scale score difference between the delayed visit group and the timely visit group (MD = 1.12, [-0.62, 2.86], p = .21). Patient delay affects the prognosis of patients with ischemic stroke and increases the risk of death, readmission, stroke recurrence, and adverse outcomes. In the future, more in-depth research is needed to verify and expand our research results.