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Pre-hospital Delay after Acute Ischemic Stroke in Central Urban China: Prevalence and Risk Factors

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Abstract

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, P = 0.028), onset location was at home (OR, 1.573, P = 0.002), and patients rather than someone else noticed the symptom onset first (OR, 1.711; P < 0.001). In contrast, knowing someone who had suffered a stroke, considering any kind of the symptoms as severe, transferring from a community-based hospital factors, calling emergency number (120), and shorter distance from the onset place to the first hospital were independently associated with decreased pre-hospital delays. These findings indicate that pre-hospital delays after AIS are common in urban central China, and future intervention programs should be focused on public awareness of stroke and appropriate response.

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Acknowledgments

The authors thank the Stroke Quality Control Center of Hubei Province and the Preventive Medicine Association of Hubei Province for supporting. The authors also thank all study participants who have been involved and contributed to the procedure of data collection.

Author information

Authors and Affiliations

  1. Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Yanfeng Zhou, Tingting Yang, Yanhong Gong, Wenzhen Li, Yawen Chen, Jing Li, Xiaoxv Yin & Zuxun Lu

  2. Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Mengdie Wang & Bo Hu

  3. The Stroke Quality Control Center of Hubei Province, Wuhan, 430030, China

    Bo Hu

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  1. Yanfeng Zhou
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  3. Yanhong Gong
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  4. Wenzhen Li
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  5. Yawen Chen
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  10. Zuxun Lu
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Correspondence to Xiaoxv Yin, Bo Hu or Zuxun Lu.

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Conflict of Interest

The authors declare that they have no competing interests.

Sources of Funding

This project was funded by the Stroke Quality Control Center of Hubei Province and the Preventive Medicine Association of Hubei Province. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Additional information

Novelty and Significance

1. What is new?

• The current large, cross-sectional study of 66 hospitals located in 13 major cities indicates that pre-hospital delays for AIS patients are relatively common in Hubei province, central urban China.

• Multivariate analyses show that a multitude of factors influence the delays. Patients with previous stroke, patients’ symptoms occurred at home, and patients rather than someone else noticed the symptoms first had a higher risk of delays.

2. What is relevant?

• Based on the risk factors, intervention programs, which emphasize comprehensive education of awareness of stroke and appropriate response (calling emergency number), should be implemented and critically evaluated.

3. Summary

Pre-hospital delays after AIS are common in urban central China, and future intervention programs should be focused on public awareness of stroke and appropriate response.

Zuxun Lu (zuxunlu@yahoo.com) is the first corresponding author.

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Zhou, Y., Yang, T., Gong, Y. et al. Pre-hospital Delay after Acute Ischemic Stroke in Central Urban China: Prevalence and Risk Factors. Mol Neurobiol 54, 3007–3016 (2017). https://doi.org/10.1007/s12035-016-9750-4

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  • DOI: https://doi.org/10.1007/s12035-016-9750-4

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