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.
Key Words
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Article info
Publication history
Published online: March 24, 2016
Accepted:
February 24,
2016
Received in revised form:
February 5,
2016
Received:
August 30,
2015
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.02.032
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
