Factors influencing delayed arrival of acute stroke patients

• Published in: Japanese Journal of Stroke Vol. 22; no. 2; pp. 301 - 306
• Main Authors: Kimura, Kazumi, Yamaguchi, Takenori, Koga, Masatoshi, Minematsu, Kazuo
• Format: Journal Article
• Language: Japanese
• Published: The Japan Stroke Society 2000
• Subjects: acut stroke; arrival delay; emergency medical service; stroke care unit; thrombolytic therapy
• ISSN: 0912-0726; 1883-1923
• DOI: 10.3995/jstroke.22.301

Although reconstructions of medical service systems for acute stroke have rapidly progressed in the United States and Europe, the current status of medical service systems remains not so changed in Japan. We investigated the factors which influence arrival time after stroke onset to a tertiary care center, and surveyed the current status of primary stroke care in the northern part of Osaka prefecture. The subjects for the "arrival time study" consisted of 518 consecutive patients with acute stroke (364 men and 154 women ; mean age, 65.9 years), who were admitted to our stroke care unit between March 1991 and August 1996. We divided the patients into three groups according to their arrival time : early admission ( ≤ 3 hours ; group E, n = 97), intermediately early admission (3 to 6 hours ; group M, n = 68), and late admission (> 6 hours ; group L, n = 345). We examined age, sex, distance from place of onset to our hospital, time of stroke onset, admission via other clinics or hospitals, stroke subtypes, initial neurologic deficits, NIH Stroke Scale (NIHSS) score on admission, history of visit to our hospital, and means of transportation, among the three groups. Factors associated with delay in arrival were stroke onset during sleep (18%, 48% and 37% in groups E, M and L, respectively, p = 0.0001), and admission via other clinics or hospitals (33%, 51% and 66%, p<0.0001). Patients with mild deficits at stroke onset were less frequent in group E as compared to the other groups. The mean values for the NIHSS score were 8.5, 5.8 and 5.2 in groups E, M and L, respectively (p<0.0001). Lacunar infarction was observed more frequently in groups M (40%) and L (45%) than in group E (16%). Conversely, cardioembolic stroke was less frequent in the former two groups (12% and 14%) than in the latter group (36%, p<0.0001) . In the "primary stroke care study", we sent out a questionnaire concerning acute stroke to 585 clinics without beds in the northem Osaka territory, which has a population of about 1, 500, 000. We received 407 replies (69.6 %) . About 24% of patients with mild deficits or TIA were not transferred to hospital within a day of onset. About 56% of primary care physicians experienced difficulties in finding a referral hospital. To begin acute stroke treatment effectively within 3 to 4 hours, we need to establish better emergency care and transportation systems for acute stroke patients, and to educate the public and health workers about "brain attacks".