Abstract Details

Title Reasons for Prehospital Delay in Acute Ischemic Stroke: a Prospective Cohort Study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-048

Objective

The aim of this study was to understand the reasons leading to prehospital delays in acute ischemic stroke (AIS).

Background Prehospital delays jeopardize the chances for patients with AIS to be treated with recanalization therapies. Population-based education campaigns aiming at reducing prehospital delay are expensive and of questionable benefit.

Design/Methods In this prospective cohort study, we included patients with AIS admitted to the Stroke Center of the University Hospital Basel between 2015 and 2017. AIS had to be confirmed on DWI-MRI. Trained study nurses interviewed patients at bedside along a standardized 28-item questionnaire on the prehospital phase. Prehospital delay was defined as delay >4.5 hours between AIS onset and admission to our hospital.

Results Overall, 337 patients were enrolled, of which 140 (42%) reached our hospital with a prehospital delay, while 197 (58%) arrived on time. In multivariate analysis, risk factors for prehospital delay were a prehospital visit to the family doctor (OR 3.49, 95%-CI 1.54-7.93, P < 0.01); lack of knowledge about stroke (OR 3.98, 95%-CI 2.32-6.72, P < 0.01); living alone (OR 1.84, 95%-CI 1.09-3.11, P = 0.02), and low NIHSS (OR 0.91, 95%-CI 0.86-0.98, P = 0.01). Lack of knowledge about stroke was associated with diabetes mellitus (OR 2.28, 95%-CI 1.21-4.27, P = 0.01), but not with a history of stroke (OR 0.62, 95%-CI 0.36-1.08, P = 0.09).

Conclusions In our cohort, prehospital delay was frequent. Two main risk factors of prehospital delay are modifiable, i.e. prehospital visit to the family doctor and lack of knowledge on stroke. Family doctors should be seen as partners, and information campaigns targeting family doctors may contribute reducing prehospital delay. Knowledge on stroke was not higher among patients with a history stroke. This underscores the need for improved patient information regarding the importance of avoiding prehospital delay in case of a recurrent stroke.

Authors/Disclosures
Joachim Fladt, MD (Unispital Basel) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
Christopher Traenka, MD (University Hospital Basel)	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Henrik Gensicke, MD (University Hospital Basel)	No disclosure on file
Nils Peters (Klinik Hirslanden)	No disclosure on file
Leo Bonati, MD	No disclosure on file
Stefan T. Engelter, MD (University Hospital Neurology Clinic)	No disclosure on file
Philippe A. Lyrer, MD (University Hospital Basel)	No disclosure on file
Gian Marco De Marchis, MD (University Hospital Basel)	No disclosure on file

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