In-hospital delays in treating patients with acute ischemic stroke

• Published in: Japanese Journal of Stroke Vol. 43; no. 3; pp. 206 - 213
• Main Authors: Suzuki, Yu, Akiyama, Hisanao, Hoshino, Masashi, Kashima, Satoru, Hara, Daisuke, Tsuchihashi, Yoko, Isahaya, Kenji, Sakurai, Kenzo, Maki, Futaba, Hasegawa, Yasuhiro, Yamano, Yoshihisa
• Format: Journal Article
• Language: Japanese
• Published: The Japan Stroke Society 2021
• Subjects: diagnostic delay; in-hospital stroke; ischemic stroke; thrombolytic therapy; triage system
• ISSN: 0912-0726; 1883-1923
• DOI: 10.3995/jstroke.10834

Background and purpose: The purpose of this study was to determine the factors for delayed diagnosis and treatment of in-hospital stroke. Methods: We retrospectively analyzed the data of consecutive patients with in-hospital stroke. We divided the patients into the early group (within 3 hours) and the delayed group (more than 3 hours) based on the time from the onset to the treatment by a stroke specialist, and analyzed the factors related to the delayed group by multivariate analysis. Results: There were 89 in-hospital stroke patients (mean age 73.6±9.0 years) registered from January 2012 to December 2014. In the early group of 37 patients, 62.2% of them had contraindications to iv-tPA. Compared to the delayed group, the early group included more patients with atrial fibrillation (17 cases, 45.9%) and more nurses as first callers (78.4%). Notably, it took 53.6±31.2 minutes for taking images even in the early group. Multivariate logistic analysis revealed that the “first caller was a doctor” was a significant factor for delay (OR=8.572, 95% CI 2.186–33.617, p=0.002), and the presence of atrial fibrillation was a significant avoidance factor for delay (OR=0.140, 95% CI 0.024–0.801, p=0.027). Conclusions: Three factors were considered to be important factors for delay (the location of discover, job type of the first discoverer, and the response of the primary doctor), suggesting the importance to build an in-hospital triage system and to educate medical staff.