title: [Delays before and after arrival at the hospital in the treatment of strokes].
abstract: BACKGROUND
  Only a minority of patients with acute stroke are eligible for fibrinolysis, and the main reason for this is that time runs out and goes beyond the therapeutic window. The chief delay occurs prior to arrival at the hospital, but there is also a nosocomial delay, which has received far less attention.
  
  
  OBJECTIVE
  The purpose of our study was to describe the data on delays occurring before and after arrival at the hospital in a sample of patients with acute stroke, and to analyse possible associated factors, including the overload on health care services in the Emergency department, an aspect that has not previously been evaluated.
  
  
  METHODS
  Epidemiological data, times of delays before and after entering the hospital, means of transport used and the health care workload in the Emergency department of the day of admission were collected for all the stroke patients admitted to the Stroke Unit of the Hospital General Universitario de Alicante throughout the period under study.
  
  
  RESULTS
  From an initial sample of 460 patients, 423 were finally included in the study, with a mean delay before and after admission to hospital of 3.99 and 2.36 hours, respectively. Use of an ambulance and the haemorrhagic and transient ischemic attack subtypes were linked to a shorter delay before reaching the hospital, and arrival during the night shift was the only factor associated to a longer delay once inside the hospital.
  
  
  CONCLUSIONS
  In our environment, there is a need to establish strategies aimed at shortening the times stroke patients take to reach the hospital and the time that elapses before they are attended.
authors.affiliation: Hospital General Universitario de Alicante, Pintor Baeza s/n, E-03010 Alicante, Spain. nilohe@terra.es
authors.forename: N
authors.initials: N
authors.lastname: López-Hernández
authors.forename: A
authors.initials: A
authors.lastname: García-Escrivá
authors.forename: J
authors.initials: J
authors.lastname: Sánchez-Payá
authors.forename: P
authors.initials: P
authors.lastname: Llorens-Soriano
authors.forename: M
authors.initials: M
authors.lastname: Alvarez-Saúco
authors.forename: A
authors.initials: A
authors.lastname: Pampliega-Pérez
authors.forename: F
authors.initials: F
authors.lastname: Gracia-Fleta
authors.forename: J
authors.initials: J
authors.lastname: Carneado-Ruiz
authors.forename: J M
authors.initials: JM
authors.lastname: Moltó-Jordá
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D013997:Time Factors; D014187:Transportation of Patients; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents