TY - JOUR
T1 - Treatment Delays and Chance of Reperfusion Therapy in Patients with Acute Stroke
T2 - A Danish Nationwide Study
AU - Mainz, Jeppe
AU - Andersen, Grethe
AU - Valentin, Jan Brink
AU - Gude, Martin Faurholdt
AU - Johnsen, Søren Paaske
N1 - © 2022 S. Karger AG, Basel.
PY - 2022/10/31
Y1 - 2022/10/31
N2 - Introduction: We aimed to determine the treatment delay for ischemic stroke patients in Denmark. Methods: A nationwide register-based study on acute ischemic stroke patients admitted through emergency medical services. Treatment delay comprised patient, prehospital, and in-hospital delay. Analyses were stratified according to length of prehospital delay (<3 vs. ≥3 h). Results: A total of 5,356 ischemic stroke episodes were included. The median onset-to-door time was 187 min, and 2,405 (43%) arrived at the stroke unit within 3 h. Overall, the median patient delay was 115 min. For early arrival (n = 2,280), patient delay was 27 min compared to 437 min for late arrivals (n = 2,448). Median prehospital delay varied by 9 min between early- and late-arriving patients. Approximately 48% of the early-arriving patients compared to 9% of the late-arriving patients received i.v. thrombolysis. For thrombectomy, the numbers were 10% and 3%, respectively. This corresponded to an unadjusted relative risk (RR) of 0.18 (95% CI: 0.16-0.21) and adjusted (age, sex, cohabitation status, and stroke severity) RR of 0.20 (95% CI: 0.18-0.23) for i.v. thrombolysis when comparing patients arriving later than 3 h with patients arriving earlier. For thrombectomy, the unadjusted and adjusted RRs were 0.30 (95% CI: 0.23-0.39) and 0.40 (95% CI: 0.31-0.52), respectively. Conclusions: Patient delay remains the most important barrier for use of reperfusion therapy among acute ischemic stroke patients calling 1-1-2, whereas system delay seems independent of patient delay.
AB - Introduction: We aimed to determine the treatment delay for ischemic stroke patients in Denmark. Methods: A nationwide register-based study on acute ischemic stroke patients admitted through emergency medical services. Treatment delay comprised patient, prehospital, and in-hospital delay. Analyses were stratified according to length of prehospital delay (<3 vs. ≥3 h). Results: A total of 5,356 ischemic stroke episodes were included. The median onset-to-door time was 187 min, and 2,405 (43%) arrived at the stroke unit within 3 h. Overall, the median patient delay was 115 min. For early arrival (n = 2,280), patient delay was 27 min compared to 437 min for late arrivals (n = 2,448). Median prehospital delay varied by 9 min between early- and late-arriving patients. Approximately 48% of the early-arriving patients compared to 9% of the late-arriving patients received i.v. thrombolysis. For thrombectomy, the numbers were 10% and 3%, respectively. This corresponded to an unadjusted relative risk (RR) of 0.18 (95% CI: 0.16-0.21) and adjusted (age, sex, cohabitation status, and stroke severity) RR of 0.20 (95% CI: 0.18-0.23) for i.v. thrombolysis when comparing patients arriving later than 3 h with patients arriving earlier. For thrombectomy, the unadjusted and adjusted RRs were 0.30 (95% CI: 0.23-0.39) and 0.40 (95% CI: 0.31-0.52), respectively. Conclusions: Patient delay remains the most important barrier for use of reperfusion therapy among acute ischemic stroke patients calling 1-1-2, whereas system delay seems independent of patient delay.
KW - Emergency medical services
KW - Onset to treatment
KW - Stroke
KW - Thrombectomy
KW - Thrombolytic therapy
KW - Time factors
KW - Time to treatment
UR - http://www.scopus.com/inward/record.url?scp=85144153627&partnerID=8YFLogxK
U2 - 10.1159/000526733
DO - 10.1159/000526733
M3 - Journal article
C2 - 36315990
JO - Cerebrovascular Diseases
JF - Cerebrovascular Diseases
SN - 1015-9770
ER -