title: Time to admission in acute ischemic stroke and transient ischemic attack.
abstract: OBJECTIVE
  The effect of thrombolysis depends on the time from stroke onset to treatment and therefore also on the time when patients come to the hospital. This study was designed to analyze the variables that influence the time from symptom onset to admission (TTA) to the stroke unit.
  
  
  METHODS
  We evaluated the medical records of 615 consecutive stroke or transient ischemic attack (TIA) patients admitted to our neurological department within 48 hours after symptom onset.
  
  
  RESULTS
  The median TTA was 180 minutes. Referral by emergency medical services (EMS; P<0.001), high National Institutes of Health Stroke Scale (NIHSS) scores (P<0.001), strokes in the carotid territory (P<0.001), and strokes not attributable to small vessel disease (P<0.001) were associated with shorter prehospital delays. The TTA was adjusted for travel times (adjTTA), and all these variables remained significantly associated with time to admission. In addition, patients with previous experience with stroke or TIA had longer adjTTA (P=0.028). Regression analysis confirmed the independent association between referral by EMS (P=0.010), high NIHSS scores (P<0.001), carotid territory stroke (P<0.001), and first-ever cerebrovascular event (P=0.022) with shorter adjTTA.
  
  
  CONCLUSIONS
  Factors such as NIHSS scores and stroke location influence the time to admission but, unlike referral pathways, cannot be modified. Educational programs and stroke campaigns should therefore not only teach typical and less common stroke symptoms and signs but also that EMS provides the fastest means of transportation to a stroke unit and the best chances to get treatment early.
authors.affiliation: Department of Neurology, University of Bern, Inselspital, 3010 Bern, Switzerland.
authors.forename: Osei
authors.initials: O
authors.lastname: Agyeman
authors.forename: Krassen
authors.initials: K
authors.lastname: Nedeltchev
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
authors.forename: Luca
authors.initials: L
authors.lastname: Remonda
authors.forename: Joerg
authors.initials: J
authors.lastname: Isenegger
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schroth
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications*; D002340:Carotid Artery Diseases / Q000150:complications; D003710:Demography; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012017:Referral and Consultation; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors; D014715:Vertebrobasilar Insufficiency / Q000150:complications