(Stroke. 1995;26:2233-2237.)
© 1995 American Heart Association, Inc.
Articles |
Delay in Neurological Attention and Stroke Outcome
From the Section of Neurology, Hospital Dr Josep Trueta, Girona (A.D.); Department of Neurology, Hospital Xeral de Galicia, Santiago de Compostela (J.C.); and Department of Neurology, Clinica Universitaria, Pamplona (E.M.-V.), Spain.
Background and Purpose Despite efforts to reduce the delay between stroke onset and new interventional treatments, no studies have analyzed the repercussions of early neurological attention on the clinical outcome of stroke patients.
Methods Data were obtained from 721 patients admitted
consecutively for a transient ischemic attack or stroke to the
neurology departments of 18 Spanish hospitals that followed the same
diagnostic and therapeutic guidelines in the acute phase.
Factors assessed were age, sex, Canadian Stroke Scale score on
admission, previous Barthel Index, and delay before attention by the
first physician, by emergency services, by a neurologist, and before
hospitalization. Patients' outcomes were classified as good (Barthel
Index >60) or poor (Barthel Index 
60 or in-hospital death)
depending on patients' functional capacity on discharge. The
individual contribution of each of these variables on clinical
outcome was estimated with logistic regression analysis.
Results Patients in worse neurological condition on admission presented earlier to the first physician, emergency department, and neurologist. The mortality rate was not significantly modified by early or late presentation at the different medical stages. Logistic regression analysis revealed that the relative risk of poor outcome in patients seen by the neurologist after the first 6 hours from symptom onset was 5.6 (95% confidence interval, 3.4 to 9.2) (P<.0001). Multiple linear regression analysis showed that the delay before the patient received neurological attention correlated positively with the duration of hospitalization (P<.0001). The delays before the patient was seen by the first physician or the emergency department and before hospitalization were not independently related to clinical outcome or length of hospitalization.
Conclusions Early neurological attention in acute stroke is related to better functional outcome and shorter hospitalization.
Key Words: clinical trials • hospitalization • stroke onset • stroke outcome
This article has been cited by other articles:
 |
|
 |
|
  A. Pedragosa, J. Alvarez-Sabin, C. A Molina, C. Sanclemente, M C. Martin, F. Alonso, and M. Ribo Impact of a telemedicine system on acute stroke care in a community hospital J Telemed Telecare, July 1, 2009; 15(5): 260 - 263. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.J. Hopyan, D.J. Gladstone, G. Mallia, J. Schiff, A.J. Fox, S.P. Symons, B.H. Buck, S.E. Black, and R.I. Aviv Renal Safety of CT Angiography and Perfusion Imaging in the Emergency Evaluation of Acute Stroke AJNR Am. J. Neuroradiol., November 1, 2008; 29(10): 1826 - 1830. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. P. de la Ossa, J. Sanchez-Ojanguren, E. Palomeras, M. Millan, J. F. Arenillas, L. Dorado, C. Guerrero, S. Abilleira, and A. Davalos Influence of the stroke code activation source on the outcome of acute ischemic stroke patients Neurology, April 8, 2008; 70(15): 1238 - 1243. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. D. Lyden, A. Shuaib, K. R. Lees, A. Davalos, S. M. Davis, H.-C. Diener, J. C. Grotta, T. J. Ashwood, H.-G. Hardemark, H. H. Svensson, et al. Safety and Tolerability of NXY-059 for Acute Intracerebral Hemorrhage: The CHANT Trial Stroke, August 1, 2007; 38(8): 2262 - 2269. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Brown, L. D. Lisabeth, N. M. Garcia, M. A. Smith, and L. B. Morgenstern Emergency department evaluation of ischemic stroke and TIA: The BASIC Project Neurology, December 28, 2004; 63(12): 2250 - 2254. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Irimia, E. Martinez-Vila, J. R. Lynch, and D. T. Laskowitz Diagnostic Test for Acute Cerebral Ischemia * Panel of Serum Markers for Rapid Diagnosis of Acute Stroke Stroke, June 1, 2004; 35(6): e140 - e141. [Full Text] [PDF]
|
|
|
|
 |
|
 J. E. Stahl, K. L. Furie, S. Gleason, and G. S. Gazelle Stroke: Effect of Implementing an Evaluation and Treatment Protocol Compliant with NINDS Recommendations Radiology, September 1, 2003; 228(3): 659 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.S. Burgin, L. Staub, W. Chan, PhD;, T.H. Wein, R.A. Felberg, J.C. Grotta, A.M. Demchuk, S.L. Hickenbottom, and L.B. Morgenstern Acute stroke care in non-urban emergency departments Neurology, December 11, 2001; 57(11): 2006 - 2012. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. R. Lacy, D.-C. Suh, M. Bueno, and J. B. Kostis Delay in Presentation and Evaluation for Acute Stroke : Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.) Stroke, January 1, 2001; 32(1): 63 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Chamorro, N. Vila, C. Ascaso, and R. Blanc Heparin in Acute Stroke With Atrial Fibrillation: Clinical Relevance of Very Early Treatment Arch Neurol, September 1, 1999; 56(9): 1098 - 1102. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Mines, S. Rosenzweig, J. F. Campa, J. L. Stolz, L. F. Palma, A. Villa, M. Bonacina, S. Paese, E. Omboni, D. L. Schriger, et al. Reducing Treatment Delay and Improving Diagnostic Accuracy for Patients With Acute Stroke JAMA, January 6, 1999; 281(1): 31 - 34. [Full Text] [PDF]
|
|
|
|
|
|
M. J. Alberts, S. Chaturvedi, G. Graham, R. L. Hughes, D. G. Jamieson, F. Krakowski, E. Raps, and P. Scott Acute Stroke Teams : Results of a National Survey Stroke, November 1, 1998; 29(11): 2318 - 2320. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. C. Tilley, P. D. Lyden, T. G. Brott, M. Lu, S. R. Levine, K. M. A. Welch, and National Institute of Neurological Disorders and S Total Quality Improvement Method for Reduction of Delays Between Emergency Department Admission and Treatment of Acute Ischemic Stroke Arch Neurol, December 1, 1997; 54(12): 1466 - 1474. [Abstract] [PDF]
|
|
|
|
|
|
J. S. Kim and S. S. Yoon Perspectives of Stroke in Persons Living in Seoul, South Korea : A Survey of 1000 Subjects Stroke, June 1, 1997; 28(6): 1165 - 1169. [Abstract] [Full Text]
|
|
|
|
|
|
A. Davalos, W. Ricart, F. Gonzalez-Huix, S. Soler, J. Marrugat, A. Molins, R. Suner, and D. Genis Effect of Malnutrition After Acute Stroke on Clinical Outcome Stroke, June 1, 1996; 27(6): 1028 - 1032. [Abstract] [Full Text]
|
|