Determinants of Using EMS or Attending Emergency Department after Minor Stroke and High-risk Transient Ischemic Attack in Henan, China (original) (raw)
Related papers
Factors delaying hospital arrival after acute stroke in southern Taiwan
Chang Gung medical journal, 2002
Acute stroke management emphasizes prompt recognition of symptoms and early medical attention. The effectiveness of stroke treatment is highly dependent on amount of time lapsed between onset of symptoms and treatment. In this study, factors that delayed seeking medical attention after stroke in southern Taiwan were explored. This was a prospective one-center study in which information was collected from patients who arrived at the emergency department of the study hospital within 48 hours after stroke onset. All the data were categorized into arrival time less than 2 hours (T < 2 hours) and from 2 to 48 hours (T = 2-48 hours) after stroke onset. There were 789 stroke patients screened and 197 (25%) of them fulfilled the inclusion criteria. Among the 197 patients, 52 (26%) arrived at the study hospital within 2 hours of stroke (median, 75 minutes) and 145 (74%) arrived between 2-48 hours (median, 575 minutes). Among patients with T = 2-48 hours, 47 (24%) patients initially sought...
Pre-hospital Delay after Acute Ischemic Stroke in Central Urban China: Prevalence and Risk Factors
Molecular neurobiology, 2016
Timely thrombolytic treatment is paramount after acute ischemic stroke (AIS); however, a large proportion of patients experience substantial delays in presentation to hospital. This study evaluates the prevalence and risk factors in pre-hospital delays after AIS in central urban China. AIS patients from 66 hospitals in 13 major cities across Hubei Province, between October 1, 2014 and January 31, 2015 were interviewed and their medical records were reviewed to identify those who suffered pre-hospital delays. Bivariate and multivariate analyses were undertaken to determine the prevalence rates and the risk factors associated with pre-hospital delays. A total of 1835 patients were included in the analysis, with 69.3 % patients reportedly arrived at hospital 3 or more hours after onset and 55.3 % patients arrived 6 or more hours after onset. Factors associated with increased pre-hospital delays for 3 or more hours were as follows: patient had a history of stroke (odds ratio (OR), 1.319...
Neurological Research, 2013
Objective: We aimed to evaluate the management of patients with transient ischemic attack (TIA) and minor stroke in China. Methods: Data from the China National Stroke Registry (CNSR) were used to identify patients who were admitted to 132 urban hospitals across China with TIA or minor stroke. Factors associated with delayed presentation to hospital were evaluated. Univariate and multivariate analyses were performed to analyze relationships between patient characteristics and time of presentation. Results: Of the 7467 patients entered into the CNSR (1204 with TIA, 6263 with minor stroke), 780 patients (64.78%) with TIA and 3467 patients (55.36%) with minor stroke had delayed presentation to hospital (.24 hours). In both groups, factors associated with early presentation ((24 hours) included transportation by ambulance and direct presentation to the emergency room. In patients with minor stroke, early presentation was associated with older age (65-80 years), motor and sensory symptoms, speech impairment, atrial fibrillation, previous TIA, and living in central or eastern China; and delayed presentation was associated with female sex, cognitive dysfunction, and diabetes. In patients with TIA, early presentation was associated with motor symptoms, and delayed presentation was associated with headache or vertigo. Discussion: In China, many patients with TIA and minor stroke do not seek medical treatment immediately. Further education is needed to teach members of the public about the warning signs and symptoms of TIA and minor stroke, and encourage the use of ambulance transportation after TIA or stroke.
International Journal of Nursing Sciences
Objective: The objective of the study was to identify facilitators and barriers to emergency medical service use among acute ischemic stroke patients in Korea. Methods: This paper presents a secondary analysis of a retrospective survey that collected data from questionnaires and medical records. Among 233 acute ischemic stroke patients enrolled in a large-scale study, 160 patients who had arrived at a hospital within 72 h after symptom onset were included in the data analysis. Results: Users of emergency medical services needed a shorter time than non-users to arrive at hospital (140 min vs. 625 min., p ¼ 0.001) and were more likely to arrive at hospital within 3 h of symptom onset (51.9% vs. 31.5%, p ¼ 0.013). For those who first contacted emergency medical service, the facilitators of emergency medical service use were the presence of hemiparesis (p ¼ 0.003), bilateral paralysis (p ¼ 0.040), and loss of balance (p ¼ 0.021). The predominant barrier was the failure to recognize the urgency of symptoms (p ¼ 0.006). Conclusions: The use of emergency medical services reduced prehospital delay and increased the likelihood of patient arrival at hospital within 3 h. Given that experiencing typical stroke symptoms was a facilitator of emergency medical service use yet failure to recognize the urgency of symptoms was a barrier, public awareness should be raised as regards stroke symptoms and the benefits of using emergency medical services.
Scientific reports, 2016
This study aimed to explore pre-hospital delay and its associated factors in first-ever stroke registered in communities from three cities in China. The rates of delay greater than or equal to 2 hours were calculated and factors associated with delays were determined by non-conditional binary logistic regression, after adjusting for different explanatory factors. Among the 403 cases of stroke with an accurate documented time of prehospital delay, the median time (interquartile range) was 4.00 (1.50-14.00) hours. Among the 544 cases of stroke with an estimated time range of prehospital delay, 24.8% of patients were transferred to the emergency department or hospital within 2 hours, only 16.9% of patients with stroke were aware that the initial symptom represented a stroke, only 18.8% used the emergency medical service and one-third of the stroke cases were not identified by ambulance doctors. In the multivariate analyses, 8 variables or sub-variables were identified. In conclusion, p...
Patterns of Emergency Medical Services Use and Its Association With Timely Stroke Treatment
Circulation: Cardiovascular Quality and Outcomes, 2013
Background— Prior studies found that only about half of stroke patients arrived at hospitals via emergency medical services (EMSs), yet since then, there have been efforts to increase public awareness that time is brain. Using contemporary Get With the Guidelines-Stroke data, we assessed nationwide EMS use by stroke patients. Methods and Results— We analyzed data from 204 591 patients with ischemic and hemorrhagic stroke admitted to 1563 Get With the Guidelines-Stroke participating hospitals with data on National Institute of Health Stroke Score and insurance status. Hospital arrival by EMSs was observed in 63.7% of patients. Older patients, those with Medicaid and Medicare insurance, and those with severe stroke were more likely to activate EMSs. In contrast, minority race and ethnicity and living in rural communities were associated with decreased odds of EMS use. EMS transport was independently associated with earlier arrival (onset-to-door time, ≤3 hours; adjusted odds ratio, 2....
Activation of Emergency Medical Services for Acute Stroke in a Nonurban Population
Stroke, 2000
Background and Purpose —Activating emergency medical services (EMS) is the most important factor in reducing delay times to hospital arrival for stroke patients. Determining who calls 911 for stroke would allow more efficient targeting of public health initiatives. Methods —The T.L.L. Temple Foundation Stroke Project is an acute stroke surveillance and intervention project in nonurban East Texas. Prospective case ascertainment allowed chart abstraction and structured interviews for all hospitalized stroke patients to determine if EMS was activated, and if so, by whom. Results —Of 429 validated strokes, 38.0% activated EMS by calling 911. Logistic regression analysis comparing those who called 911 with those who did not activate EMS found that individuals who were employed were 81% less likely to have EMS activated (OR 0.19, 95% CI 0.04 to 0.63). Of the 163 cases in which 911 was called, the person activating EMS was: self (patient), 4.3%; family member of significant other, 60.1%; p...
Frontiers in neurology, 2017
The epidemiological characteristics of transient ischemic attacks (TIAs) in China are unclear. In 2013, we conducted a nationally representative, door-to-door epidemiological survey on TIA in China using a complex, multistage, probability sampling design. Results showed that the weighted prevalence of TIA in China was 103.3 [95% confidence interval (CI): 83.9-127.2] per 100,000 in the population, 92.4 (75.0-113.8) per 100,000 among men, and 114.7 (87.2-151.0) per 100,000 among women. The weighted incidence of TIA was 23.9 (17.8-32.0) per 100,000 in the population, 21.3 (14.3-31.5) per 100,000 among men, and 26.6 (17.0-41.7) per 100,000 among women. No difference in average prognosis was found between TIA and stroke in the population. Weighted risk of stroke among TIA patients was 9.7% (6.5-14.3%), 11.1% (7.5-16.1%), and 12.3% (8.4-17.7%) at 2, 30, and 90 days, respectively. The risk of stroke was higher among male patients with a history of TIA than among female patients with a hist...