Factors Associated with Delayed Admission to Hospital Among Acute Stroke Patients
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- Category: Vol. 77, June 2009
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Factors Associated with Delayed Admission to Hospital Among Acute Stroke Patients in Jordanian hospitals,MIMI M. MAKKAWY and SHOKRIA A. LABEEB
Abstract
Background and Aims: Early treatment and admission to hospital followed by correct diagnosis with minimum delay is critical for successful intervention in acute stroke. The aim of this study was to describe delays in presentation to hospital and in the emergency department (ED) management of patients with acute stroke and to identify factors influencing these delays in governmental Jordanian hospitals.
Subject and Methods: A quantitative descriptive correlation study was used. Data were collected from hospital records, and a questionnaire was administered that included questions about socio demographics, self-reported risk factors and questions related to hospital arrival. Time from onset of symptoms to admission (admission time) was prospectively documented during a year period from march 2007 to February 2008 in patients consecutively admitted for an acute focal neurological deficit presented at arrival and of presumed vascular origin. Mode of transportation, patient’s knowledge and correct recognition of stroke symptoms were assessed. The rate of patients arriving at the hospital more than 3 hours after symptom onset was found to be 38.75 for this study. Approximately 1/3 of patients delayed going to the hospital because they were waiting for symptoms to go. There was a significant relationship between the use of ambulance trans-portation and length of time before arrival at the hospitals, though there was no statistically significantly relationship between the existence of stroke risk factors and hospital arrival delay. The influence of referral patterns on in hospital delays was further evaluated.
Results: Overall, 160 patients were included, 91 had an Acute ischemic stroke and 22 a haemorrhagic stroke. Twenty-five patients had a TIA with neurological symptoms subsiding within the first hours after admission. Median admission time was 3 hours 20 minutes. Transportation by ambulance signif-icantly shortened admission delays in comparison with the (p<0.05) The only other factor associated with reduced delays was awareness of stroke (HR 1.9, 95% CI 1.3-2.9). Early in-hospital delays, specifically time to request CT-scan and time to call the physician, were shorter when the patient was referred by his family or to a lesser extent by an emergency physician than by the family physician (p 76.08% and 23.91% respectively) with highly significant difference (p<0.000) and were shorter when he was transported by ambulance than by his own means (p<0.0).
Conclusions: Transportation by ambulance and referral by the patient or family significantly improved admission delays and early in-hospital management. Correct recognition
of stroke symptoms further contributed to significant shortening of admission time so the researchers recommended educational programmes should take these findings into account.