title: Factors influencing emergency delays in acute stroke management.
abstract: OBJECTIVE
  Early admission to hospital with minimum delay is a prerequisite for successful management of acute stroke. We sought to determine our local pre- and in-hospital factors influencing this delay.
  
  
  METHODS
  Time from onset of symptoms to admission (admission time) was prospectively documented during a 6-month period (December 2004 to May 2005) in patients consecutively admitted for an acute focal neurological deficit presented at arrival and of presumed vascular origin. Mode of transportation, patient's knowledge and correct recognition of stroke symptoms were assessed. Physicians contacted by the patients or their relatives were interviewed. The influence of referral patterns on in-hospital delays was further evaluated.
  
  
  RESULTS
  Overall, 331 patients were included, 249 had an ischaemic and 37 a haemorrhagic stroke. Forty-five patients had a TIA with neurological symptoms subsiding within the first hours after admission. Median admission time was 3 hours 20 minutes. Transportation by ambulance significantly shortened admission delays in comparison with the patient's own means (HR 2.4, 95% CI 1.6-3.7). The only other factor associated with reduced delays was awareness of stroke (HR 1.9, 95% CI 1.3-2.9). Early in-hospital delays, specifically time to request CT-scan and time to call the neurologist, were shorter when the patient was referred by his family or to a lesser extent by an emergency physician than by the family physician (p < 0.04 and p < 0.01, respectively) and were shorter when he was transported by ambulance than by his own means (p < 0.01).
  
  
  CONCLUSIONS
  Transportation by ambulance and referral by the patient or family significantly improved admission delays and early in-hospital management. Correct recognition of stroke symptoms further contributed to significant shortening of admission time. Educational programmes should take these findings into account.
authors.affiliation: Department of Internal Medicine, Medical School, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Lucka
authors.initials: L
authors.lastname: Sekoranja
authors.forename: Anne Claude
authors.initials: AC
authors.lastname: Griesser
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Wagner
authors.forename: Alfred K
authors.initials: AK
authors.lastname: Njamnshi
authors.forename: Philippe
authors.initials: P
authors.lastname: Temperli
authors.forename: François R
authors.initials: FR
authors.lastname: Herrmann
authors.forename: Raphael
authors.initials: R
authors.lastname: Grandjean
authors.forename: Marc
authors.initials: M
authors.lastname: Niquille
authors.forename: Bernard
authors.initials: B
authors.lastname: Vermeulen
authors.forename: Olivier T
authors.initials: OT
authors.lastname: Rutschmann
authors.forename: François
authors.initials: F
authors.lastname: Sarasin
authors.forename: Roman
authors.initials: R
authors.lastname: Sztajzel
mesh_terms: D000208:Acute Disease; D000368:Aged; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D010343:Patient Admission; D010820:Physicians; D012017:Referral and Consultation; D020521:Stroke / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014187:Transportation of Patients