J Stroke.  2015 May;17(2):159-167. 10.5853/jos.2015.17.2.159.

Factors Associated with Early Hospital Arrival in Patients with Acute Ischemic Stroke

• Song D
• Tanaka E
• Lee K
• Sato S
• Koga M
• Kim YD
• Nagatsuka
• Toyoda K
• Heo JH

• KMID: 2223672
• DOI: http://doi.org/10.5853/jos.2015.17.2.159

Abstract

BACKGROUND AND PURPOSE
Factors associated with early arrival may vary according to the characteristics of the hospital. We investigated the factors associated with early hospital arrival in two different stroke centers located in Korea and Japan.
METHODS
Consecutive patients with ischemic stroke arrived hospital within 48 hours of onset between January 2011 and December 2012 were identified and the clinical and time variables were retrieved from the prospective stroke registries of Severance Hospital of Yonsei University Health System (YUHS; Seoul, Korea) and National Cerebral and Cardiovascular Center (NCVC; Osaka, Japan). Subjects were dichotomized into early (time from onset to arrival < or =4.5 hours) and late (>4.5 hours) arrival groups. Univariate and multivariate analyses were performed to evaluate factors associated with early hospital arrival.
RESULTS
A total of 1,966 subjects (992 from YUHS; 974 from NCVC) were included in this study. The median time from onset to arrival was 6.1 hours [interquartile range, 1.7-17.8 hours]. In multivariate analysis, the factors associated with early arrival were atrial fibrillation (Odds ratio [OR], 1.505; 95% confidence interval [CI], [1.168-1.939]), higher initial National Institute of Health Stroke Scale scores (OR, 1.037; 95% CI [1.023-1.051]), onset during daytime (OR, 2.799; 95% CI [2.173-3.605]), and transport by an emergency medical service (OR, 2.127; 95% CI [1.700-2.661]). These factors were consistently associated with early arrival in both hospitals.
CONCLUSIONS
Despite differences between the hospitals, there were common factors related to early arrival. Efforts to identify and modify these factors may promote early hospital arrival and improve stroke outcome.

Keyword

Acute stroke therapy; Cerebral infarction; Early hospital arrival; Prehospital delay; Emergency medical service; Countries

MeSH Terms

Atrial Fibrillation
Cerebral Infarction
Emergency Medical Services
Humans
Japan
Korea
Multivariate Analysis
Registries
Seoul
Stroke*