Factors associated with delayed revascularization in patients with ischemic stroke: a prospective study in one French region.
Journal
European journal of emergency medicine : official journal of the European Society for Emergency Medicine
ISSN: 1473-5695
Titre abrégé: Eur J Emerg Med
Pays: England
ID NLM: 9442482
Informations de publication
Date de publication:
01 Feb 2022
01 Feb 2022
Historique:
pubmed:
7
9
2021
medline:
24
12
2021
entrez:
6
9
2021
Statut:
ppublish
Résumé
Optimizing the care pathway of stroke is crucial for the revascularization of ischemic stroke. to identify factors associated with (1) a time interval over 4 h between the symptom onset and cerebral imaging in suspected stroke patients and (2) the absence of revascularization in patients with ischemic stroke. Patients over 18 years old with a suspected stroke admitted in 22 emergency rooms or stroke units in one French region between 1 March 2019 and 30 April 2019 were prospectively included by filling a dedicated form. Factors associated with the previously mentioned outcome measures were identified using logistic regression models. In total 991 patients were included; 537 patients (64% of 845 with available time intervals) were admitted more than 4 h after symptom onset. Three predictors were identified: not calling emergency medical services (EMS) [odds-ratio (OR) 5.2; 95% confidence interval (3.4-8.1)], a preexisting autonomy loss [2.0 (1.3-2.9)] and atypical clinical presentation [2.0 (1.3-3.1)]. A total of 385 patients had an ischemic stroke of whom 93 underwent a revascularization procedure (24%). The same three predictors were associated with the absence of revascularization procedure, added to an initial admission in a hospital without stroke unit [3.1 (1.1-8.6)]. This study shows that efforts to organize the care chain for stroke need to be intensified in the region to reduce treatment time intervals, which could include information campaigns focused on the impact of EMS call and the clinical presentation recognition.
Sections du résumé
BACKGROUND AND IMPORTANCE
BACKGROUND
Optimizing the care pathway of stroke is crucial for the revascularization of ischemic stroke.
OBJECTIVES
OBJECTIVE
to identify factors associated with (1) a time interval over 4 h between the symptom onset and cerebral imaging in suspected stroke patients and (2) the absence of revascularization in patients with ischemic stroke.
DESIGN, SETTINGS AND PARTICIPANTS
METHODS
Patients over 18 years old with a suspected stroke admitted in 22 emergency rooms or stroke units in one French region between 1 March 2019 and 30 April 2019 were prospectively included by filling a dedicated form.
OUTCOME MEASURES AND ANALYSIS
METHODS
Factors associated with the previously mentioned outcome measures were identified using logistic regression models.
MAIN RESULTS
RESULTS
In total 991 patients were included; 537 patients (64% of 845 with available time intervals) were admitted more than 4 h after symptom onset. Three predictors were identified: not calling emergency medical services (EMS) [odds-ratio (OR) 5.2; 95% confidence interval (3.4-8.1)], a preexisting autonomy loss [2.0 (1.3-2.9)] and atypical clinical presentation [2.0 (1.3-3.1)]. A total of 385 patients had an ischemic stroke of whom 93 underwent a revascularization procedure (24%). The same three predictors were associated with the absence of revascularization procedure, added to an initial admission in a hospital without stroke unit [3.1 (1.1-8.6)].
CONCLUSION
CONCLUSIONS
This study shows that efforts to organize the care chain for stroke need to be intensified in the region to reduce treatment time intervals, which could include information campaigns focused on the impact of EMS call and the clinical presentation recognition.
Identifiants
pubmed: 34483249
doi: 10.1097/MEJ.0000000000000875
pii: 00063110-202202000-00013
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
56-62Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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