Factors affecting the presentation time of patients with acute stroke to hospital and level of awareness of thrombolytic therapy

Abstract

Aim:In this study, it was aimed to reveal the factors affecting the time of presentation of patients with acute stroke to the hospital, determine the rates of benefiting from thrombolytic therapy and assess the thrombolytic therapy awareness of patients.
Material and Method: 276 patients with acute stroke were included in our study. Standard structured questionnaire was administered to the patients. Patients were asked about the time of onset of stroke, age, place of residence, level of education, whether they received thrombolytic therapy, what was done as the first intervention, and whether they had information about thrombolytic therapy. Stroke severity was also evaluated by applying the National Institutes of Health Stroke Scale (NIHSS) to the patients.
Results: Of the patients included in the study, 218 (79%) had ischemic stroke, 26 (9.4%) had intracerebral hemorrhage and 32 (11.6%) had TIA. The mean NIHH score of the patients was 6.7±6.2. Stroke onset time was mainly between 18.00-24.00 with a rate of 28.3%. It was understood that 83.1% of the patients came to the emergency department by ambulance and 16.9% came by their own vehicle. When the groups of patients who received and did not receive thrombolytic therapy were compared, no significant difference was found between who the patient lived with at home and the groups of the level of education. Statistical significance was found with symptom onset time (p<0.05). Significant differences were found when the time of presentation to the hospital was compared with the place of residence, type of stroke and symptom onset time (p<0.05).
Conclusion: When the results are evaluated, it is necessary to reduce the delay time of patients with acute stroke, especially outside the hospital. Increasing the awareness of the patients about the symptoms of stroke and early treatment techniques will help to reduce mortality and morbidity.

Keywords

• Cerebrovascular disease
• thrombolytic therapy
• delayed treatment

References

1. Ropper AH, Brown RH. Cerebrovascular diseases. Adams and Victor’s principles of Neurology 2005; 10: 778-884.
2. Hankey G. Preventable stroke and stroke prevention. J Thrombosis Haemostasis 2005; 3: 1638-45.
3. Feigin VL, Krishnamurthi RV, Parmar P, et al. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: the GBD 2013 study. Neuroepidemiology 2015; 45: 161-76.
4. Boehme AK, Esenwa C, Elkind MS. Stroke risk factors, genetics, and prevention. Circulat Res 2017; 120: 472-95.
5. (Tuik) TİK. Ölüm Nedeni İstatistikleri. http: //www.tuik.gov.tr/PreHaberBultenleri.do?id=30626 Erişim: 25.11.2019 2018.
6. Şahan M, Satar S, Koç AF, Ahmet S. İskemik inme ve akut faz reaktanları. Arşiv Kaynak Tarama Derg 2010; 19: 85-140.
7. Lees KR, Bluhmki E, Von Kummer R, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. The Lancet 2010; 375: 1695-703.
8. Fransen PS, Berkhemer OA, Lingsma HF, et al. Time to reperfusion and treatment effect for acute ischemic stroke: a randomized clinical trial. JAMA Neurol 2016; 73: 190-6.

9. Doggen CJ, Zwerink M, Droste HM, et al. Prehospital paths and hospital arrival time of patients with acute coronary syndrome or stroke, a prospective observational study. BMC Emerg Med 2016; 16: 1-10.
10. Denti L, Caminiti C, Scoditti U, et al. Impact on prehospital delay of a stroke preparedness campaign: a SW-RCT (Stepped-Wedge Cluster Randomized Controlled Trial). Stroke 2017; 48: 3316-22.
11. Yanagida T, Fujimoto S, Inoue T, Suzuki S. Prehospital delay and stroke-related symptoms. Intern Med 2015; 54: 171-7.
12. Baldereschi M, Di Carlo A, Vaccaro C, Polizzi B, Inzitari D. Stroke knowledge in Italy. Neurologic Sci 2015; 36: 415-21.
13. Jorgensen H, Nakayama H, Reith J, Raaschou H, Olsen T. Factors delaying hospital admission in acute stroke: the Copenhagen Stroke Study. Neurology 1996; 47: 383-7.
14. Kıyan S, Özsaraç M, Ersel M, et al. Acil servise başvuran akut iskemik inmeli 124 hastanın geriye yönelik bir yıllık incelenmesi. Akademik Acil Tıp Derg 2009; 8: 15-20.
15. TUNÇ C. İnmeli bireylerin hastaneye başvurma sürelerini etkileyen etmenlerin incelenmesi DEÜ Sağlık Bilimleri Enstitüsü 2011.
16. Soto-Cámara R, González-Santos J, González-Bernal J, et al. Factors associated with shortening of prehospital delay among patients with acute ischemic stroke. J Clin Med 2019; 8: 1712.
17. Keskin Ö, Kalemoğlu M, Ulusoy E, Uzun H, Yıldırım İ. Akut inmeli olgularda hastane öncesi geçikme nedenlerinin irdelenmesi. PREVALENCE 2005; 30: 38.
18. Faiz KW, Sundseth A, Thommessen B, Rønning OM. Factors related to decision delay in acute stroke. J Stroke Cerebrovasc Dis 2014; 23: 534-9.
19. Korkmaz T, Ersoy G, Kutluk K, et al. An evaluation of pre-admission factors affecting the admission time of patients with stroke symptoms. Turk J Emerg Med 2010; 10: 106-11.
20. Evenson KR, Rosamond WD, Morris DL. Prehospital and in-hospital delays in acute stroke care. Neuroepidemiology 2001; 20: 65-76.
21. Fladt J, Meier N, Thilemann S, et al. Reasons for prehospital delay in acute ischemic stroke. J Am Heart Assoc 2019; 8: e013101.
22. Faiz KW, Sundseth A, Thommessen B, Rønning OM. Prehospital delay in acute stroke and TIA. Emerg Med J 2013; 30: 669-74.
23. Yalçın E, Yalçın M, Çelik Y, Ekuklu G. Risk factors for recurrent ischemic stroke in Turkey. Trakya Üniversitesi Tıp Fakültesi Derg 2008.
24. Kabakçi G, Abaci A, Ertaş FS, et al. Türkiye’de hipertansif hastalarda inme riski ve inme riski açısından bölgesel farklılıkların belirlenmesi: Hastane tabanlı, kesitsel, epidemiyolojik anket (THİNK) çalışması. Türk Kardiyoloji Derneği Arşivi 2006; 34: 395-405.