Factors Associated with Delay in Arrival of Acute Stroke Patients in Phan Hospital
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Abstract
Introduction: Acute stroke is one of the leading world health problems due to its high morbidity and mortality rates. Stroke incidence is increasing rapidly each year and causes more economic burden for each new patient. One of the effective ways in the treatment of acute ischemic stroke is to receive a thrombolysis agent within the time limit, 3.5 hours from the onset of symptoms for patients who visit Phan Hospital. And we found out that more than half of patients who present with the symptoms of acute stroke have arrived too late and lost this opportunity.
Objective: To investigate factors that have an association to delay in the arrival of acute stroke patients in Phan Hospital.
Method: A cross-sectional study on acute stroke patients that visit Phan Hospital and have been referred to Chiangrai Prachanukroh Hospital for definitive diagnosis and treatment from 2017 to 2021. Information was collected by retrospective medical review between May, 1st 2021 to January, 1st 2022. Univariate logistic regression and multivariate logistic regression were used to identify associations to delaying the arrival of the patients.
Results: Of the 1,791 patients, only 653 (36.5%) had arrived on time. 137 (7.6%) patients had called an ambulance. In multivariate analysis, factors associated with late arrival were not using an emergency medical service (OR 1.73, p 0.038), onset of symptoms between 00.01 am. to 04.00 am. (OR 6.67, p <0.001), not known the time of onset (OR 47.60, p <0.001), present with seizure (OR 0.20, p <0.001), present with alteration of consciousness (OR 0.60, p 0.058), Glasgow coma score (OR 1.10, p 0.008), result in hemorrhagic stroke (OR 0.52, p 0.001) and result in transient ischemic attack (OR 0.39, p 0.005).
Conclusion: Many patients had lost their chance of receiving thrombolysis drugs due to their late arrival at the hospital. Some of these associating factors are controllable such as alcohol use and calling an ambulance. A community project to inform patients at risk to modify these factors may result in earlier arrival in the future.
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References
World Stroke Organization. World Stroke Organization (WSO) annual report 2019 [Internet]. 2019 [cited 2020 Sep 15]. Available from: https://www.world-stroke.org/assets/downloads/WSO_2019_Annual_Report_online.pdf
กองโรคไม่ติดต่อ กรมควบคุมโรค กระทรวงสาธารณสุข. จำนวนและอัตราผู้ป่วยใน ปี 2559 - 2561 (ความดันโลหิตสูง, เบาหวาน, หลอดเลือดหัวใจ, หลอดเลือดสมอง, COPD) ต่อประชากรแสนคน 100,000 คน (รวมทุกการวินิจฉัยโรค) จำแนกรายจังหวัด เขตบริการสุขภาพ และภาพรวมประเทศ (รวมกรุงเทพมหานคร) [อินเทอร์เน็ต]. 2562 [เข้าถึงเมื่อ 15 ก.ย. 2563]. เข้าถึงได้จาก: http://www.thaincd.com/document/file/info/non-communicable-disease/%E0%B8%88%E0%B8%B3%E0%B8%99%E0%B8%A7%E0%B8%99%E0%B9%81%E0%B8%A5%E0%B8%B0%E0%B8%AD%E0%B8%B1%E0%B8%95%E0%B8%A3%E0%B8%B2%E0%B8%9B%E0%B9%88%E0%B8%A7%E0%B8%A2%E0%B9%82%E0%B8%A3%E0%B8%84NCDs2559-2561.xlsx
ทัศนีย์ ตันติฤทธิศักดิ์, บรรณาธิการ. แนวทางการรักษาโรคหลอดเลือดสมองตีบหรืออุดตันสำหรับแพทย์. พิมพ์ครั้งที่ 2. กรุงเทพฯ: หจก. จีซัคเซสพริ้นติ้ง; 2555.
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke 2018;49:e46-e99. doi: 10.1161/STR.0000000000000158.
Lacy CR, Suh DC, Bueno M, Kostis JB. Delay in presentation and evaluation for acute stroke. Stroke 2001;32:65-69. doi: 10.1161/01.STR.32.1.63.
Ashraf VV, Maneesh M, Praveenkumar R, Saifudheen K, Girija AS. Factors delaying hospital arrival of patients with acute stroke. Ann Indian Acad Neurol 2015;18(2):162–166. PMID: 26019412. doi: 10.4103/0972-2327.150627.
Arulprakash N, Umaiorubahan M. Causes of delayed arrival with acute ischemic stroke beyond the window period of thrombolysis. J Family Med Prim Care 2018;7(6):1248–1252. PMID: 30613505. doi: 10.4103/jfmpc.jfmpc_122_18.
ปิยนุช รักชื่อ, สิริกัลยา พูลผล. ปัจจัยที่มีผลต่อความล่าช้าก่อนถึงโรงพยาบาลในผู้ป่วยโรคสมองขาดเลือดเฉียบพลันในโรงพยาบาลราชวิถี. J Thai Stroke Soc. 2562;18(1):5-13.
ธภัทร หวานณรงค์, สงคราม โชติกอนุชิต, ยงชัย นิละนนท์. การศึกษาปัจจัยที่สัมพันธ์ต่อระยะเวลาในการมาโรงพยาบาลในผู้ป่วยโรคหลอดเลือดสมองเฉียบพลัน. J Med Assoc Thai 2562;102(5):1-7.
ศรัทธาวุธ วงษ์เวียงจันทร์, จุฬาลักษณ์ โกมลตรี, นิพนธ์ พวงวรินทร์, ยงชัย นิละนนท์. ความตระหนักรู้เรื่องโรคหลอดเลือดสมองและปัจจัยที่ส่งผลต่อระยะเวลาของการมารับการรักษาที่โรงพยาบาล การศึกษาแบบไปข้างหน้า. J Med Assoc Thai 2015;98(3):260-4.
Haki C, Cetiner M, Kaya H. Factors affecting the arrival time to hospital of patients with acute ischemic stroke. Sanamed 2020;15(2):145-51. doi: 10.24125/sanamed.v15i2.419.
Memis S, Tugrul E, Evci ED, Ergin F. Multiple causes for delay in arrival at hospital in acute stroke patients in Aydin, Turkey. BMC Neurol 2008;8:15. doi:10.1186/1471-2377-8-15.
Al Khathaami AM, Mohammad YO, Alibrahim FS, Jradi HA. Factors associated with late arrival of acute stroke patients to emergency department in Saudi Arabia. SAGE Open Med . 2018;6:2050312118776719. PMID: 29844910. doi:10.1177/2050312118776719.
Iyer R. Prevalence and reasons for pre-hospital delay after acute ischemic stroke: data from a single tertiary care centre in Coimbatore, South India. Neurology 2020;94(15):406.
Smith MA, Doliszny KM, Shahar E, McGovern PG, Arnett DK, Luepker RV. Delayed hospital arrival for acute stroke: the Minnesota stroke survey. Ann Intern Med 1998;129(3):190-6. doi:10.7326/0003-4819-129-3-199808010-00005.
Sobral S, Taveira I, Seixas R, Vicente AC, Duarte J, Goes AT, et al. Late hospital arrival for thrombolysis after stroke in Southern Portugal: who is at risk? . J Stroke Cerebrovasc Dis 2019;28(4):900-5. doi:10.1016/j.jstrokecerebrovasdis.2018.12.009.
Khalema D, Goldstein LN, Lucas S. A retrospective analysis of time delays in patients presenting with stroke to an academic emergency department. S Afr J radiol 2018;22:1. doi:10.4102/sajr.v22i1.1319.
Salisbury HR, Banks BJ, Footitt DR, Winner SJ, Reynolds DJM. Delay in presentation of patients with acute stroke to hospital in Oxford. Q J Med 1998;91:635-40. doi:10.1093/qjmed/91.9.635.
Rossnagel K, Jungehülsing GJ, Nolte CH, Müller-Nordhorn J, Roll S, Wegscheider K, et al. Ann Emerg Med 2004;44(5):476-83. doi:10.1016/j.annemergmed.2004.06.019.
Song D, Tanaka E, Lee K, Sato S, Koga M, Kim YD, et al. Factors associated with early hospital arrival in patients with acute ischemic stroke. J Stroke 2015;17(2):159-167. doi:10.5853/jos.2015.17.2.159.
Kim YS, Park SS, Bae HJ, Cho AH, Cho YJ, Han MK, et al. Stroke awareness decreases prehospital delay after acute ischemic stroke in Korea. BMC Neurol 2011;11:2. doi:10.1186/1471-2377-11-2.
Hewedi KM, Mohamed MEDT, Sleem MAYA. Pre hospital and hospital delays after the onset of acute ischemic stroke in a sample of Egyptian patients. Al-Azhar Med J 2019;48(4):311-22. doi: 10.12816/amj.2019.64940.