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Factors delaying hospital admission after acute stroke
R Fogelholm1, K Murros, A Rissanen
1Department of Neurology, Central Hospital of Central Finland.
Insights
Delays in hospital admission for acute stroke patients are common, often exceeding recommended times. Improving public and medical education can significantly reduce these delays, improving patient outcomes.
Area of Science:
- Neurology
- Public Health
Background:
- Early hospital admission is critical for acute stroke treatment.
- New stroke therapies are most effective when administered within the first hours of symptom onset.
Purpose of the Study:
- To identify factors contributing to delayed hospital admission in acute stroke patients.
- To analyze patient referral patterns and their impact on treatment timelines.
Main Methods:
- Analysis of a database of first-time stroke patients in Central Finland (1993).
- Inclusion of patients referred to the sole tertiary referral hospital in the region.
- CT scans used to confirm stroke subtype in 98% of admitted patients.
Main Results:
- A significant delay in hospital admission was observed in most acute stroke cases.
- Referral patterns were the primary cause of delay: direct admission (2 hours), local physician consultation (8 hours), and health center observation (47 hours).
- Ischemic stroke and stroke onset during off-hours (evenings, nights, weekends) also contributed to delays.
Conclusions:
- Most patients eligible for acute stroke trials experience prolonged delays.
- Public and medical personnel education are crucial for reducing admission delays.
- Targeted interventions can improve timely access to stroke care.
Background And Purpose:
Clinical trials of new drugs that reverse neurological deficits when used in the first hours of stroke onset suggest that early hospital admission is important. We analyzed a database of patients with acute stroke to determine the factors that delay hospital admission.
Methods:
We analyzed all patients with their first stroke during 1993 in the province of Central Finland (population, 256 000). Patients referred to the Central Hospital, the only tertiary referral hospital in the area, were included in the study.
Results:
Of the patients with first stroke, 363 (79%) were admitted to the Central Hospital. The stroke subtype was confirmed in 356 (98%) patients with CT scan, and the patient population included 272 (75%) with brain infarction, 51 (14%) with intracerebral hemorrhage, and 40 (11%) with subarachnoid hemorrhage. The most important factor associated with a delay in reaching the hospital was the referral pattern. The median delay was 2 hours for patients brought directly to the Central Hospital, 8 hours if a physician at the local health center was consulted, and 47 hours if the patient was first admitted to the health center for observation. Other factors associated with a delay were ischemic stroke and stroke onset in the evening or night or during the weekend.
Conclusions:
The majority of patients who are candidates for acute stroke trials arrive at the hospital after prolonged delays for multiple reasons. Public and medical personnel education could result in signficant reduction in these delays.