Factors Associated with Early Presentation and Rapid Imaging Evaluation of Acute Stroke

Lee, Seung Chul; Kim, Won; Lim, Kyoung Soo

Abstract

PURPOSE
This study was designed to identify factors associated with early presentation at the Emergency Department (ED) after stroke onset and rapid imaging evaluation of acute stroke in the ED.
METHODS
This prospective study was performed from November 2002 to April 2003 at the ED of a university hospital in Seoul. We studied all patients presenting directly to the ED within 48 hours of the onset of stroke. Univariate and multivariate analyses with Cox's proportional hazard model were performed to evaluated the factors influencing the time from symptom onset to ED arrival and from ED arrival to imaging evaluation.
RESULTS
One hundred sixty-three patients were enrolled in this study: 128 subjects (78.5%) with ischemic stroke and 35 (21.5%) with intracerebral hemorrhage (ICH). 47.9% of patients presented within 3 hours of symptom onset and 63.8% within 6 hours. Early ED arrival was significantly associated with initial severity (baseline NIHSS score >13 scores){Hazard rate ratio(HR) 2.4, 95%CI 1.5-3.6}, ICH (HR 1.5, 95%CI 1.0-2.3) and transport by 119 ambulance (HR 1.5, 95%CI 1.1-2.1). Rapid imaging evaluation was significantly associated with initial severity (baseline NIHSS score >13 scores) (HR 2.9, 95%CI 1.9-4.3) and ICH (HR 1.6, 95%CI 1.1-2.4). The chief complaint of dizziness (HR 0.5, 95%CI 0.3-0.9) was significantly associated with delayed imaging evaluation.
CONCLUSION
The use of 119 ambulance reduced delays in hospital arrival after acute stoke. Dizziness increased delays in imaging evaluation after arrival. Increased encouragement to use 119 ambulance and educational effort on dizziness will reduce this delays.