title: Time to hospital admission and start of treatment in patients with ischemic stroke in northern Italy and predictors of delay.
abstract: OBJECTIVE
  Early treatment (i.e. thrombolysis) is crucial for a successful care of ischemic stroke. In the management of stroke, two phases are crucial: the pre-hospital and the in-hospital interval. This work investigated factors influencing pre- and in-hospital delay in a large geographic area of Northern Italy.
  
  
  METHODS
  Enrolled were patients presenting with ischemic stroke in four administrative districts of Northern Italy (Como, Lecco, Sondrio and Varese) over a 4-month period. Pre-hospital time and in-hospital time with single management steps were recorded prospectively. Age, gender, recruiting hospital, EMS transport and triage codes, clinical severity and thrombolytic treatment were also recorded. Univariate and multivariate analysis of factors predicting pre- and in-hospital delay were performed.
  
  
  RESULTS
  Median pre-hospital time and in-hospital time were, respectively, 120 min (interquartile range, IQR 62-271) and 150 min (IQR 80-214). Pre-hospital time was halved in patients hospitalized via EMS (p<0.001) and clinically more severe (p<0.001). At multivariate analysis, transport code was associated with delay at any time (p<0.05).
  
  
  CONCLUSIONS
  EMS use and transport code predicted treatment delay in patients with ischemic stroke. A more intensive use of EMS and high urgency codes could help increase the number of stroke patients treated appropriately.
authors.affiliation: Neurological Department, Sant'Anna Hospital, Como, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Vidale
authors.forename: Ettore
authors.initials: E
authors.lastname: Beghi
authors.forename: Francesca
authors.initials: F
authors.lastname: Gerardi
authors.forename: Claudio
authors.initials: C
authors.lastname: De Piazza
authors.forename: Silvia
authors.initials: S
authors.lastname: Proserpio
authors.forename: Marco
authors.initials: M
authors.lastname: Arnaboldi
authors.forename: Giacomo
authors.initials: G
authors.lastname: Bezzi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bono
authors.forename: Giampiero
authors.initials: G
authors.lastname: Grampa
authors.forename: Mario
authors.initials: M
authors.lastname: Guidotti
authors.forename: Patrizia
authors.initials: P
authors.lastname: Perrone
authors.forename: Daniele
authors.initials: D
authors.lastname: Porazzi
authors.forename: Davide
authors.initials: D
authors.lastname: Zarcone
authors.forename: Alberto
authors.initials: A
authors.lastname: Zoli
authors.forename: Elio
authors.initials: E
authors.lastname: Agostoni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000628:therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome