title: Temporal trends and associated factors for pre-hospital and in-hospital delays of stroke patients over a 16-year period: the Athens study.
abstract: BACKGROUND
  The management and outcome of acute ischemic stroke changed dramatically after the introduction of intravenous thrombolysis. However, relatively few patients have received thrombolytic treatment, mainly due to pre-hospital and/or in-hospital delays. Although the causes of these delays have been adequately studied, their change over a long period has not.
  
  
  METHODS
  All acute first-ever stroke patients (n = 2,746) presenting to our academic center from 1993 to 2008 were prospectively documented in a computerized stroke data bank. The time from symptoms onset to presentation at the emergency room and to acquisition of a brain CT was calculated. Time trends over this period as well as the factors affecting them were analyzed.
  
  
  RESULTS
  The final study cohort consisted of 2,326 acute stroke patients after excluding 302 patients with an unknown time of stroke onset and 118 who suffered a stroke during hospitalization for another illness. Over the 16-year period, the median time from stroke onset to presentation at the emergency room decreased significantly from 3.15 h (interquartile range 1.30-10.30) to 2.00 h (range 1.00-4.00) (p < 0.001). The median time from emergency room presentation to CT scan completion also decreased significantly (p < 0.001) from 12.3 h (range 4.1-29.8) to 1.0 h (range 0.31-2.77). As a result, the proportion of patients having a CT scan within 4 h of stroke onset increased significantly from 8.6% in 1993-1994 to 53.6% in 2007-2008 (p < 0.001). Thrombolytic treatment was applied in 4.15% of all ischemic stroke patients in the period from 2003 to 2008. Along with other significant factors, use of an emergency medical service was associated with a 57% greater chance of presenting within 3 h after symptoms onset.
  
  
  CONCLUSIONS
  These results suggest a continued improvement in pre-hospital and in-hospital delays for stroke management. Public awareness and education regarding medical and paramedical services are necessary for the best early management of acute stroke patients.
authors.affiliation: Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Papapanagiotou
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Iacovidou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spengos
authors.forename: Theodoros
authors.initials: T
authors.lastname: Xanthos
authors.forename: Ioannis
authors.initials: I
authors.lastname: Zaganas
authors.forename: Afrodite
authors.initials: A
authors.lastname: Aggelina
authors.forename: Athanasios
authors.initials: A
authors.lastname: Alegakis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Vemmos
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016009:Chi-Square Distribution; D019992:Databases as Topic; D004632:Emergency Medical Services / Q000639:trends*; D004636:Emergency Service, Hospital / Q000639:trends*; D005260:Female; D006115:Greece; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000639:trends*; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000639:trends*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000639:trends; D016896:Treatment Outcome