Effects of Community-based Stroke Education and Advocacy on the Time from Stroke Onset to Hospital Arrival in Ischemic Stroke Patients

Background: Stroke is the second leading cause of death in Korea and the prevalence of acute ischemic stroke among older adults continues to grow, which is known to be related to delayed hospital arrival after the onset of symptoms. Thus, decreasing the incidence of elderly stroke is a major health promotion objective in Korea, yet little is reported about the factors associated with the delayed medical care seeking behavior among elderly stroke patients in Korea. Purpose: The purpose of this study was to understand factors of delayed medical care seeking among elderly stroke patients in order to develop intervention strategies to improve the health of this population. Methods: A cross-sectional, descriptive study was conducted in a convenience sample of 233 hospitalized elderly patients with acute ischemic stroke using a self-administered survey. Descriptive statistics and chi-square test were used for data analysis. Results: More than half of them were male (60.5%) with age of 61 and older (76.9%), and relied on the opinion of their children or friends when deciding medical care for stroke (58.3%). Regarding the reasons of seeking medical care, there was no statistical significance between individuals who arrived at a hospital within three hours of the onset of symptoms and who arrived after three hours. Reasons for delayed hospital arrival were significantly different between groups (individuals of hospital arrival within three hours vs. individuals with hospital arrival after three hours), which include lack of knowledge about the severity of stroke and unawareness of symptoms (χ2 = 24.1), or inconvenience of a hospital visit, waiting for the effects of alternative medications, and stroke during sleep (χ2 = 55.1) with p <0.001. Conclusions: In conclusion, this study helped identify factors delaying hospital arrival after the onset of symptoms among Korean elderly stroke patients. Interventions should include stroke education focusing on the severity of stroke and related symptoms. The stroke education should target not only elderly stroke patients but their family members and friends. It may result in overall national health by decreasing prevalence of stroke among Korean elderly population.

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Time interval between stroke onset and hospital arrival in acute ischemic stroke patients in Shanghai, China

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2010.09.004 ◽

2011 ◽

Vol 113 (2) ◽

pp. 85-88 ◽

Cited By ~ 13

Author(s):

Jing Fang ◽

Weihong Yan ◽

Guo-Xin Jiang ◽

Wei Li ◽

Qi Cheng

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Onset ◽

Time Interval ◽

Stroke Patients ◽

Hospital Arrival

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Abstract TP230: Prehospital Timeline of Mobile Stroke Treatment Unit and Traditional Ambulance

Stroke ◽

10.1161/str.48.suppl_1.tp230 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jason Mathew ◽

Andrew Blake Buletko ◽

Ather Taqui ◽

Andrew Reimer ◽

Stacey Winners ◽

...

Keyword(s):

Ischemic Stroke ◽

Final Diagnosis ◽

Stroke Patients ◽

Treatment Unit ◽

Hospital System ◽

Hospital Arrival ◽

Stroke Treatment ◽

Early Evaluation ◽

Acute Stroke Treatment ◽

The Times

Introduction: Prehospital evaluation and response is vital to effective and early delivery of acute stroke treatment. We aimed to compare the times across various prehospital times among stroke patients arriving by municipal EMS and MSTU. Methods: We performed a retrospective study of 107 patients with a final diagnosis of ischemic stroke within our hospital system from June 2014 to July 2015. We compared on scene arrival, hospital arrival, and time of physician assessment of patients evaluated on MSTU to traditional municipal EMS. Times are reported as medians and groups were compared by Rank-Sum Test. Results: Of 107 patients, 49 patients were evaluated by traditional EMS and 58 evaluated by MSTU. Time from dispatch to scene arrival was median 9 min (IQR 5.5 - 12min) in EMS group and median 12 min (IQR 8-16 min) n MSTU (p&lt0.01). Time on scene was 17 min (IQR 14 - 24min) in EMS group and median 42 min (IQR 36-48 min) in MSTU. There was no difference within the MSTU group in time on-scene among those treated with IV tpA (43 min) and those without (41 min, p=.08 ). After dispatch, patients arrived in hospital by EMS earlier (median 40 min, IQR 33-49min) than by MSTU (median 72 min, IQR 58-81min, p&lt.01), but patients on MSTU were evaluated by a physician at median 28 (IQR 21.5-34.5) min after dispatch. Conclusion: Early evaluation of ischemic stroke patients with MSTU, doubles the time on scene compared to municipal EMS.

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Emergency Medical Services Support for Acute Ischemic Stroke Patients Receiving Thrombolysis at a Primary Stroke Center

Journal of brain disease ◽

10.4137/jcnsd.s2221 ◽

2009 ◽

Vol 1 ◽

pp. JCNSD.S2221

Author(s):

Byron R. Spencer ◽

Omar M. Khan ◽

Bentley J. Bobrow ◽

Bart M. Demaerschalk

Keyword(s):

Decision Making ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Stroke Onset ◽

Stroke Patients ◽

Emergency Medical ◽

Field Assessment ◽

Primary Stroke Center ◽

Stroke Center

Background Emergency Medical Services (EMS) is a vital link in the overall chain of stroke survival. A Primary Stroke Center (PSC) relies heavily on the 9-1-1 response system along with the ability of EMS personnel to accurately diagnose acute stroke. Other critical elements include identifying time of symptom onset, providing pre-hospital care, selecting a destination PSC, and communicating estimated time of arrival (ETA). Purpose Our purpose was to evaluate the EMS component of thrombolysed acute ischemic stroke patient care at our PSC. Methods In a retrospective manner we retrieved electronic copies of the EMS incident reports for every thrombolysed ischemic stroke patient treated at our PSC from September 2001 to August 2005. The following data elements were extracted: location of victim, EMS agency, times of dispatch, scene, departure, emergency department (ED) arrival, recordings of time of stroke onset, blood pressure (BP), heart rate (HR), cardiac rhythm, blood glucose (BG), Glasgow Coma Scale (GCS), Cincinnati Stroke Scale (CSS) elements, emergency medical personnel field assessment, and transport decision making. Results Eighty acute ischemic stroke patients received thrombolysis during the study interval. Eighty-one percent arrived by EMS. Two EMS agencies transported to our PSC. Mean dispatch-to-scene time was 6 min, on-scene time was 16 min, transport time was 10 min. Stroke onset time was recorded in 68%, BP, HR, and cardiac rhythm each in 100%, BG in 81%, GCS in 100%, CSS in 100%, and acute stroke diagnosis was made in 88%. Various diagnostic terms were employed: cerebrovascular accident in 40%, unilateral weakness or numbness in 20%, loss of consciousness in 16%, stroke in 8%, other stroke terms in 4%. In 87% of incident reports there was documentation of decision-making to transport to the nearest PSC in conjunction with pre-notification. Conclusion The EMS component of thrombolysed acute ischemic stroke patients care at our PSC appeared to be very good overall. Diagnostic accuracy was excellent, field assessment, decision-making, and transport times were very good. There was still room for improvement in documentation of stroke onset and in employment of a common term for acute stroke.

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Social factors influencing hospital arrival time in acute ischemic stroke patients

Neuroradiology ◽

10.1007/s00234-011-0884-9 ◽

2011 ◽

Vol 54 (4) ◽

pp. 361-367 ◽

Cited By ~ 12

Author(s):

Christina Iosif ◽

Mathilda Papathanasiou ◽

Eleftherios Staboulis ◽

Athanasios Gouliamos

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Social Factors ◽

Arrival Time ◽

Stroke Patients ◽

Hospital Arrival ◽

Factors Influencing

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Ischemic Stroke, Inflammation, and Endotheliopathy in COVID-19 Patients

Stroke ◽

10.1161/strokeaha.120.031971 ◽

2021 ◽

Author(s):

Lindsay S. McAlpine ◽

Adeel S. Zubair ◽

Ilavarasy Maran ◽

Pola Chojecka ◽

Paul Lleva ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Endothelial Activation ◽

Vascular Risk Factors ◽

Interquartile Range ◽

Stroke Onset ◽

Vascular Risk ◽

Stroke Patients ◽

Markers Of Inflammation ◽

Von Willebrand

Background and Purpose: Reports indicate an increased risk of ischemic stroke during coronavirus disease 2019 (COVID-19) infection. We aimed to identify patients with COVID-19 and ischemic stroke and explore markers of inflammation, hypercoagulability, and endotheliopathy, a structural and functional disturbance of the vascular endothelium due to a stressor. Methods: This was a retrospective, observational cohort study comparing acute ischemic stroke patients with and without COVID-19 across 3 hospitals. Timing of stroke onset during COVID-19 course and markers of inflammation, hypercoagulability, and endothelial activation were evaluated by COVID-19 status and stroke cause. Results: Twenty-one patients with ischemic stroke were diagnosed with COVID-19 during the study period. Patients with COVID-19 had a similar age and burden of vascular risk factors compared with the control cohort (n=168). We identified a temporal correlation between stroke onset and the peak of acute phase reactants, including CRP (C-reactive protein), ferritin, and d-dimer. In subsets of patients with labs available, embolic stroke of undetermined source was associated with elevated IL (interleukin)-6 (median, 171 [interquartile range, 13–375] versus 8 [4–11], P <0.01) and sIL (soluble IL)-2 receptor (1972 [1525–4720] versus 767 [563–1408.5], P =0.05) levels. Stroke patients with COVID-19 demonstrated elevated levels of endothelial activation markers compared with non-COVID-19 stroke controls (median von Willebrand activity 285.0% [interquartile range, 234%–382%] versus 150% [128%–183%], P =0.034; von Willebrand antigen 330.0% [265%–650%] versus 152% [130%–277%], P =0.007, and factor VIII 301% [289%–402%] versus 49% [26%–94%], P <0.001). Conclusions: Ischemic stroke in patients with COVID-19 is associated with endotheliopathy and a systemic inflammatory response in patients with vascular risk factors. Further research evaluating endothelial and inflammatory markers in the setting of ischemic stroke and COVID-19 in larger, prospective cohorts is needed to validate the findings.

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Serum omentin-1 is a novel biomarker for predicting the functional outcome of acute ischemic stroke patients

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2017-0282 ◽

2018 ◽

Vol 56 (2) ◽

pp. 350-355 ◽

Cited By ~ 9

Author(s):

Tian Xu ◽

Peng Zuo ◽

Yuqin Wang ◽

Zhiwei Gao ◽

Kaifu Ke

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Logistic Model ◽

Critical Role ◽

Stroke Onset ◽

Stroke Patients ◽

Multivariable Logistic Regression Model ◽

Poor Functional Outcome

Abstract Background: Recent studies have suggested that omentin-1 plays a critical role in the development of cardiovascular disease. However, reported findings are inconsistent, and no study has evaluated the association between omentin-1 levels and a poor functional outcome after ischemic stroke onset. Methods: A total of 266 acute ischemic stroke patients were included in this study. All patients were prospectively followed up for 3 months after acute ischemic stroke onset and a poor functional outcome was defined as a major disability or death occurring during the follow-up period. A multivariable logistic model was used to evaluate the association between serum omentin-1 levels and the functional outcome of ischemic stroke patients at 3 months. Results: Ischemic stroke patients with poor functional outcome had significantly lower levels of serum omentin-1 than patients without poor functional outcome at the 3-month follow-up (50.2 [40.2–59.8] vs. 58.3 [44.9–69.6] ng/mL, p<0.01). Subjects in the highest tertile of serum omentin-1 levels had a 0.38-fold risk of having poor functional outcome, compared with those in the lowest tertile (p<0.05). A negative association between omentin-1 levels and poor functional outcome was found (p for trend=0.02). The net reclassification index was significantly improved in predicting poor functional outcome when omentin-1 data was added to the multivariable logistic regression model. Conclusions: Higher omentin-1 levels at baseline were negatively associated with poor functional outcome among ischemic stroke patients. Omentin-1 may represent a biomarker for predicting poor functional outcome of acute ischemic stroke patients.

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Abstract W P128: The Effect of Obesity on K-Modified Barthel Index at 6 Months after Stroke: A Prospective Multicenter Study

Stroke ◽

10.1161/str.46.suppl_1.wp128 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Shin Yi Jang ◽

Yun-Hee Kim ◽

Min Kyun Sohn ◽

Jongmin Lee ◽

Deog Young Kim ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Barthel Index ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Stroke Onset ◽

Obese Group ◽

Stroke Patients ◽

Control And Prevention ◽

The Mean

Introduction: Previously, association between body mass index (BMI) and K-Modified Barthel Index (KMBI) score was reported. However, few studies investigated the value of obesity as a predictive factor of 6 months functional outcome after stroke. Aims: The aim of this study is to examine whether BMI predicts the 6-month KMBI after stroke onset with adjustment for cardiovascular disease risk factors socioeconomic position and health behavior factors in stroke patients. Methods: This is an interim report of the Korean Stroke Cohort for Functioning and Rehabilitation (KosCo). The sample included 1,299 stroke patients, both ischemic and hemorrhagic, aged 18-92 years. FIM score was assessed at 6 months after stroke onset. Subjects were classified into three groups based on their baseline BMI categories at admission: normal (18.5 ≤ BMI < 23), overweight (23 ≤ BMI < 25), or obese (BMI ≥ 25) groups. Results: The mean age was 64.1 (±12.8) years. The distribution of overweight and obese groups was 28.5 % and 36.3 %, respectively. The mean 6-month KMBI was 85.6 (±27.6) and 88.0 (±26.0), respectively. The 6-month KMBI significantly increased in obese group compared to the normal BMI group after adjustment for confounding factors. In the ischemic stroke, the 6-month KMBI was increased in the obese group (p<0.05), but not in the hemorrhagic stroke. Conclusions: This hospital-based cohort study showed that obesity measured by BMI may predict good 6 months functional outcome, especially, for the ischemic stroke patients (Supported by Korea Centers for Disease Control and Prevention (2013E3301701)).

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Abstract WP239: Ethnic Differences in Multiple Chronic Conditions Among Ischemic Stroke Patients From the Brain Attack Surveillance in Corpus Christi Project

Stroke ◽

10.1161/str.51.suppl_1.wp239 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Xiaqing Jiang ◽

Lu Wang ◽

Christine Cigolle ◽

Lynda Lisabeth

Keyword(s):

Ischemic Stroke ◽

Ethnic Differences ◽

Chronic Conditions ◽

Ethnic Difference ◽

Stroke Onset ◽

Multiple Chronic Conditions ◽

Stroke Patients ◽

Discharge Data ◽

Stroke Outcomes ◽

Younger Patients

Introduction: The risk of developing multiple chronic conditions (MCC) increases with age. MCC predicts stroke outcomes and impairs prestroke reserve that aids the neuropsychological process of stroke recovery. Mexican Americans (MAs) have increased stroke risk, worse stroke outcomes and a different profile of pre-stroke comorbidities compared to non-Hispanic whites (NHWs). We assessed ethnic differences in the overall burden of MCC among ischemic stroke patients from a bi-ethnic, population-based stroke study. Methods: We studied patients with ischemic stroke between November 2008 and March 2017. Twenty-two chronic conditions (prevalence 1%-83%) were identified from medical records and ICD-9 and 10 codes from hospital discharge data. MCC burden was measured by the total number of chronic conditions. Ethnic differences in terms of the odds of experiencing none (<2 conditions), low MCC (2-3 conditions), or high MCC (>4 conditions) were assessed using a proportional odds model adjusting for age (at stroke onset). Effect modification by age was also investigated. Results: Of 1,656 stroke patients, 68% were MA, 51% were female, mean age was 69 (SD=13), median number of MCC was 4 (IQR: 2-6). MAs were younger at stroke onset, but more likely to have higher age-adjusted MCC burden (OR 1.32, 95% CI: 1.07-1.62) compared to NHWs. The difference in MCC burden was modified by age (p= 0.02), with greater ethnic difference in MCC burden among younger patients (Figure). Conclusion: MAs have greater MCC burden at stroke onset compared to NHWs, especially in younger patients. The contribution of this ethnic difference in MCC burden to ethnic disparities in stroke outcome needs further investigation.

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Abstract WMP120: Pre-stroke Statin Enhancement of Collateralization in Acute Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.wmp120 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Mengmeng Ma ◽

Jiaying Zhu ◽

Li He

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Cerebral Artery ◽

Collateral Circulation ◽

Stroke Onset ◽

Stroke Severity ◽

Stroke Patients ◽

Statin Use

Background: Recent studies suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcome in case of stroke onset. It was speculated that pre-stroke statin may enhance collateral circulation and result in favorable functional outcome. This study aimed to investigate the association of pre-stroke statin use with leptomeningeal collaterals in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 hours from May 2011 to April 2017. CTA imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; admission NIHSS was used to measure stroke severity; modified Rankin scale (mRS) at 90 day was used to measure outcome. Univariate and multivariate analyses were performed. Results: 239 patients met inclusion criteria. 54 patients use statin before stroke onset. Pre-stroke statin use was independently associated with good collateral circulations (rLMCS>10) (OR, 4.786; 95% CI, 1.195 - 19.171; P = 0.027). Pre-stroke statin use was not independently associated with lower stroke severity (NIHSS≤14) (OR, 1.955; 95%CI, 0.657- 5.816; P = 0.228), but pre-stroke statin use was independently associated with good outcome (mRS≤2) (OR, 3.868; 95%CI, 1.325 - 11.289; P = 0.013). Conclusion: Pre-stroke statin use seems enhance collateralization and improve clinical outcomes in patients with acute stroke. However, clinical controlled studies should be used to verify this claim.

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