Abstract WP177: Factors Associated with Delays in Patient Presentation to REACH TeleStroke Hospitals in South Carolina
Introduction: Excessive prehospital delay between acute stroke onset and hospital arrival remains an ongoing problem contributing to low thrombolysis rates. The REACH Telemedicine Network of South Carolina (SC) provides neurologic expertise for acute stroke interventions to 15 hospital Emergency Departments (ED) across rural SC. Our aim was to investigate the demographic factors associated with delays in hospital presentation.
Methods: For a 51-month period, 2412 REACH consults were analyzed. Analysis was limited to those with information about the time of symptom onset and time of ED arrival. The prehospital delay time was calculated and patients were dichotomized within 180-min from symptom onset or greater. Univariate logistic regression assessed the relationship between prehospital delay and patient characteristics including age, race, sex, type of insurance (self pay, private insurance, Medicaid, Medicare, or unknown), NIHSS at admission (<10 vs >10) and the type of hospital (urban vs rural) as a surrogate for residential area. Backwards multivariate logistic regression was performed to determine the most parsimonious model of predicting factors associated with delay from symptom onset to ED arrival.
Results: Univariate analyses indicated that patients who presented greater than 180-min from symptom onset were more likely to be African American (AA) and to be self-pay rather than have insurance for services. Results of multivariate modeling further revealed that having NIHSS < 10 and being AA or self-paying for services were all associated with longer delay from symptom onset to ED arrival.
Conclusions: Data from REACH Telemedicine of SC suggest that being AA, being self-insured, and having more minor stroke symptoms are associated with delaying ED arrival to more than 3 hours. Analysis of these data has focused on patient demographic characteristics. Further studies are needed to examine other contributing factors, such as patients’ educational level, social/societal factors and hospital characteristics in order to be able to design effective population-based interventions to decrease prehospital delay in rural settings where the REACH Telemedicine network provides access to cutting-edge acute stroke care across the state of SC.
- Disease management
- Patient education/teaching psychosocial aspects
- Emergency care
- Quality of life
- © 2012 by American Heart Association, Inc.