Acute Stroke: A population based study of factors influencing delays in hospital arrival. Preliminary results.
For acute stroke therapy, most stroke patients are ineligible due to delays in presenting to hospital. Previous studies have largely been hospital based, lacking specific information about the factors influencing non hospitalised patients. To plan for acute stroke care in the new millennium, we need to identify factors that may help increase the proportion eligible for these treatments. Arrival times were assessed for patients accrued in the NorthEast Melbourne Stroke Incidence Study (NEMESIS), a large population based stroke incidence study in Australia. Patients were identified using multiple overlapping sources including 60 hospitals. Stroke onset and hospital arrival times were assessed by review of medical records and interviews with the patient or next of kin. In this preliminary analysis, we assessed 254 stroke events among 244 patients. Two hundred and twenty seven were first-ever-in-a-life time strokes. The mean age was 75 years and 40% were male. In 254 events, 7% never attended hospital and 9% were in-patient strokes. Non attenders were older (mean age 79 years), predominantly female (88%) and 65% resided in nursing homes. Median hospital arrival time for the remaining 84%, was 9.1 hours (range 25 minutes to 1 month). Thirty percent of patients presenting to hospital arrived within 3 hours of the event, and 74% within the first 24 hours. Delays were greater with contact with the General Practitioner, living alone or in patients with a history of dementia. Factors associated with earlier arrival included ambulance transport, dense hemiplegia, impaired consciousness and sub-arachnoid haemorrhage. In this preliminary analysis, we have identified factors that affect hospital arrival times. Many non hospitalised patients may be ineligible for treatment due to pre existing disability or old age, reflected in their need for nursing home accommodation. Of those who attend hospital, potentially a greater proportion of the stroke population could be eligible for acute therapies if delays in arrival could be addressed. Strategies to improve early attendance need to be targeted at both the patient and the General Practitioner.