Impact of onset-to-door time on outcomes and factors associated with late hospital arrival in patients with acute ischemic stroke

• Published in: PloS one Vol. 16; no. 3; p. e0247829
• Main Authors: Lee, Eung-Joon, Kim, Seung Jae, Bae, Jeonghoon, Lee, Eun Ji, Kwon, Oh Deog, Jeong, Han-Yeong, Kim, Yongsung, Jeong, Hae-Bong
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25.03.2021; Public Library of Science (PLoS)
• Subjects: Age; Anticoagulants; Biology and Life Sciences; Cardiac arrhythmia; Cardiovascular disease; Clinical outcomes; Computer programs; Coronary artery; Coronary artery disease; Daytime; Diabetes mellitus; Dyslipidemia; Emergency medical care; Fibrillation; Heart diseases; Hospitals; Hypertension; Ischemia; Medicine; Medicine and Health Sciences; Neurology; Night; Nighttime; Patients; Physical Sciences; Radiology; Reperfusion; Research and Analysis Methods; Risk analysis; Risk factors; Smoking; Software; Stroke; Therapy; Transient ischemic attack; Variables; South Korea
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0247829

Previous studies have reported that early hospital arrival improves clinical outcomes in patients with acute ischemic stroke; however, whether early arrival is associated with favorable outcomes regardless of reperfusion therapy and the type of stroke onset time is unclear. Thus, we investigated the impact of onset-to-door time on outcomes and evaluated the predictors of pre-hospital delay after ischemic stroke. Consecutive acute ischemic stroke patients who arrived at the hospital within five days of onset from September 2019 to May 2020 were selected from the prospective stroke registries of Seoul National University Hospital and Chung-Ang University Hospital of Seoul, Korea. Patients were divided into early (onset-to-door time, ≤4.5 h) and late (>4.5 h) arrivers. Multivariate analyses were performed to assess the effect of early arrival on clinical outcomes and predictors of late arrival. Among the 539 patients, 28.4% arrived early and 71.6% arrived late. Early hospital arrival was significantly associated with favorable outcomes (three-month modified Rankin Scale [mRS]: 0-2, adjusted odds ratio [aOR]: 2.03, 95% confidence interval: [CI] 1.04-3.96) regardless of various confounders, including receiving reperfusion therapy and type of stroke onset time. Furthermore, a lower initial National Institute of Health Stroke Scale (NIHSS) score (aOR: 0.94, 95% CI: 0.90-0.97), greater pre-stroke mRS score (aOR: 1.58, 95% CI: 1.18-2.13), female sex (aOR: 1.71, 95% CI: 1.14-2.58), unclear onset time, and ≤6 years of schooling (aOR: 1.76, 95% CI: 1.03-3.00 compared to >12 years of schooling) were independent predictors of late arrival. Thus, the onset-to-door time of≤4.5 h is crucial for better clinical outcome, and lower NIHSS score, greater pre-stroke mRS score, female sex, unclear onset times, and ≤6 years of schooling were independent predictors of late arrival. Therefore, educating about the importance of early hospital arrival after acute ischemic stroke should be emphasized. More strategic efforts are needed to reduce the prehospital delay by understanding the predictors of late arrival.