Reasons for Pre-Hospital Delay and Current Situation of Thrombolytic Therapy: A Prospective Study in a Single Center...

The aim was to investigate reasons for a pre-hospital delay in patients with acute ischemic stroke (AIS) and patients within the thrombolytic window who did not receive thrombolysis.

This study was conducted on AIS patients admitted to the stroke center through interviews and questionnaires.

Of the 160 consecutive patients included, 67 (41.9%) arrived at the emergency department (ED) within 4.5 h, and 93 (58.1%) were delayed. The early arrival patients had shorter median onset-to-arrival times (P < 0.001). Of the 93 delayed patients, 70 (75.3%) were unaware of the occurrence of a stroke, and 17 (18.3%) had the stroke onset during sleeping. Multivariate logistic regression analysis showed that private car [odds ratio (OR) 4.310, 95% confidence interval (CI) 1.732-10.728] and other traffic tools (OR 6.189, 95%CI 1.843-20.786) were independent of a delayed arrival, whereas symptomatic remission, symptomatic aggravation, education of stroke, and the Oxfordshire Community Stroke Project classification were independently related to early arriving at the hospital after a stroke. Of the 67 patients, 33 (49.3%) who arrived within the window time did not receive thrombolytic therapy. Except for minor stroke (n = 9/27.3%) and contradictions (n = 2/6.1%), the main reasons for pre-hospital delay were patients' refusal (n = 12/36.4%) and misdiagnosis on the part of the physician due to atypical symptoms (n = 4/12.1%).

Lack of stroke education, symptom stabilization, and non-emergency medical system utilization were the main reasons for the pre-hospital delay. Patients' refusal and misdiagnosis were the main reasons of patients who were eligible for thrombolytic treatment but did not finally receive thrombolysis.