title: Emergency perception and other variables associated with extra-hospital delay in stroke patients in the Maresme region (Spain).
abstract: Delay in arrival to the emergency room (ER) may negatively influence outcome of stroke patients. We aim to analyze factors that influence extra-hospital delay in stroke patients. Two hundred and ninety-two consecutive stroke patients admitted in the ER were prospectively studied. Analysis was made to identify variables associated with <1- and <3 h delays from onset. About 18.8% of patients arrived before 1 h and 57.5% before 3 h. Factors independently associated with <3 h delay were decision to go immediately to ER (OR = 8.17; 95% IC = 4.47-18.8), ambulance transportation (OR = 2.35; 1.36-4.05) and total anterior circulation syndrome (TACS) (OR = 3.74; 1.51-9.24). History of >1 vascular risk factor was associated with a greater delay (OR = 0.47; 0.26-0.86). Factors associated with a <1 h delay were: (i) immediate decision to attend the ER (OR = 3.55; 1.85-6.81), (ii) stroke on Sunday (OR = 3.46; 1.56-7.66), (iii) aphasia (OR = 2.41; 1.23-4.74), (iv) absence of stairs at home (OR = 0.37; 0.17-0.81) and (v) absence of diabetes mellitus (OR = 0.42; 0.20-0.88). In our area, nearly 60% of stroke patients arrive to ER before 3 h from onset. Immediate decision to attend the ER has the strongest association with a short delay. Patients with TACS arrived mainly before 3 h and those with isolated aphasia arrived before 1 h. Patients with vascular risk factors attended the hospital later. Ambulance transportation is associated with <3 h delay, but not with <1 h.
authors.affiliation: Unitat de Neurologia, Hospital de Mataró, Barcelona, Spain. epalomeras@csdm.cat
authors.forename: E
authors.initials: E
authors.lastname: Palomeras
authors.forename: P
authors.initials: P
authors.lastname: Fossas
authors.forename: M
authors.initials: M
authors.lastname: Quintana
authors.forename: R
authors.initials: R
authors.lastname: Monteis
authors.forename: M
authors.initials: M
authors.lastname: Sebastián
authors.forename: C
authors.initials: C
authors.lastname: Fábregas
authors.forename: A
authors.initials: A
authors.lastname: Ciurana
authors.forename: M
authors.initials: M
authors.lastname: Ribó
authors.forename: A
authors.initials: A
authors.lastname: Cano
authors.forename: P
authors.initials: P
authors.lastname: Sanz
authors.forename: M
authors.initials: M
authors.lastname: Floriach
authors.forename: J
authors.initials: J
authors.lastname: Alvarez-Sabín
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010465:Perception; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D013997:Time Factors; D014187:Transportation of Patients / Q000379:methods / Q000706:statistics & numerical data*