title: Pre-hospital Delay as Determinant of Ischemic Stroke Outcome in an Italian Cohort of Patients Not Receiving Thrombolysis.
abstract: BACKGROUND
  Pre-hospital delay in acute stroke is critical to the administration of thrombolysis and affects patients' clinical outcome. In this study, the impact of pre-hospital delay on the outcome of ischemic stroke was investigated in an Italian cohort of patients who did not receive thrombolysis.
  
  
  METHODS
  Data from a cohort of 1847 patients, suffering from first-ever ischemic stroke and referred to an in-hospital clinical pathway were analyzed retrospectively. The relationship between pre-hospital delay and 1-month mortality was assessed with adjustment for demographics, premorbid disability, and stroke severity, which was graded according to the Scandinavian Stroke Scale, with higher scores indicating less severity.
  
  
  RESULTS
  Five hundred and twelve patients (27.7%) arrived at hospital within 2 hours of symptom onset. A significant correlation was found between early arrival and a reduced risk of 1-month mortality (hazard ratio .65; 95% confidence interval .48-.89; P = .02). There was a significant interaction (P = .01) between pre-hospital delay and the neurological score on mortality in the multivariate model, and the survival advantage of early admission was significant only for patients with scores on the Scandinavian Stroke Scale less than 18 (hazard ratio .54; 95% confidence interval .34-.85; P = .008).
  
  
  CONCLUSIONS
  Our study suggests that reducing pre-hospital delay can increase the probability of survival in patients with ischemic stroke, especially those who are most severely affected. Even if the patients cannot benefit from thrombolysis, survival rates can be increased provided that they are managed according to standardized care processes.
authors.affiliation: Department of Geriatrics and Rehabilitation, Geriatric Ward, Stroke Care Section. Electronic address: ldenti@ao.pr.it.
authors.forename: Licia
authors.initials: L
authors.lastname: Denti
authors.affiliation: Department of Geriatrics and Rehabilitation, Geriatric Ward, Stroke Care Section.
authors.forename: Andrea
authors.initials: A
authors.lastname: Artoni
authors.affiliation: Department of Geriatrics and Rehabilitation, Geriatric Ward, Stroke Care Section; Department of Emergency and Internal Medicine, Stroke Care Program.
authors.forename: Umberto
authors.initials: U
authors.lastname: Scoditti
authors.affiliation: Department of Geriatrics and Rehabilitation, Geriatric Ward, Stroke Care Section.
authors.forename: Elisa
authors.initials: E
authors.lastname: Gatti
authors.affiliation: Department of Geriatrics and Rehabilitation, Geriatric Ward, Stroke Care Section.
authors.forename: Chiara
authors.initials: C
authors.lastname: Bussolati
authors.affiliation: Department of Geriatrics and Rehabilitation, Geriatric Ward, Stroke Care Section.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Ceda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019091:Critical Pathways; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult
keywords: Ischemic stroke; clinical pathway; outcome; pre-hospital delay; thrombolysis