Delayed Care in Self-Presenting Stroke Patients: Real-World Data on Process Delays-Comparing Process Times Between...

Area of Science:

• Neurology
• Emergency Medicine
• Public Health

Background:

• Stroke is a time-critical medical emergency requiring rapid diagnosis and treatment.
• Emergency Medical Services (EMS) streamline prehospital stroke care.
• Self-presentation to emergency departments bypasses EMS, potentially delaying critical treatment.

Purpose of the Study:

• To compare prehospital and in-hospital process times between EMS-transported and self-presenting stroke patients.
• To evaluate treatment outcomes, specifically intravenous thrombolysis (IVT) rates, in both patient groups.

Main Methods:

• Retrospective analysis of prospectively collected data from 1805 suspected stroke patients admitted between May 2019 and June 2021.
• Patients categorized into EMS-transported and self-presenting groups.
• Key metrics: door-to-needle time (DNT), symptom onset to first medical contact (FMC), and IVT rates.

Main Results:

• Self-presenting patients had significantly longer median onset-to-first-contact times (727 min vs. 114 min for EMS patients).
• Intravenous thrombolysis (IVT) rates were 9.9% for EMS patients and 7.1% for self-presenting patients (not statistically significant).
• In-hospital door-to-needle times were slightly longer for self-presenting patients (median 35 min vs. 30 min for EMS patients) but within targets.

Conclusions:

• Self-presenting stroke patients experience substantial prehospital delays and tend to have lower IVT rates.
• In-hospital treatment times were comparable, indicating efficient emergency department care.
• Enhanced public education is vital to promote rapid recognition of stroke symptoms and encourage timely EMS activation.