scholarly journals Factors Associated with Shortening of Prehospital Delay among Patients with Acute Ischemic Stroke

2019 ◽  
Vol 8 (10) ◽  
pp. 1712 ◽  
Author(s):  
Raúl Soto-Cámara ◽  
Josefa González-Santos ◽  
Jerónimo González-Bernal ◽  
Asunción Martín-Santidrian ◽  
Esther Cubo ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Public Awareness ◽  
Stroke Care ◽  
University Hospital ◽  
Medical Emergency ◽  
Acute Stroke Care ◽  
Cross Sectional ◽  
Factors Associated ◽  
Prehospital Delay ◽  
Awareness Campaigns

Background: Despite recent advances in acute stroke care, only 1–8% of patients can receive reperfusion therapies, mainly because of prehospital delay (PHD). Objective: This study aimed to identify factors associated with PHD from the onset of acute stroke symptoms until arrival at the hospital. Methods: A cross-sectional study was conducted including all patients consecutively admitted with stroke symptoms to Burgos University Hospital (Burgos, Spain). Socio-demographic, clinical, behavioral, cognitive, and contextualized characteristics were recorded, and their possible associations with PHD were studied using univariate and multivariable regression analyses. Results: The median PHD of 322 patients was 138.50 min. The following factors decreased the PHD and time until reperfusion treatment where applicable: asking for help immediately after the onset of symptoms (OR 10.36; 95% confidence interval (CI) 4.47–23.99), onset of stroke during the daytime (OR 7.73; 95% CI 3.09–19.34) and the weekend (OR 2.64; 95% CI 1.19–5.85), occurrence of stroke outside the home (OR 7.09; 95% CI 1.97–25.55), using a prenotification system (OR 6.46; 95% CI 1.71–8.39), patient’s perception of being unable to control symptoms without assistance (OR 5.14; 95% CI 2.60–10.16), previous knowledge of stroke as a medical emergency (OR 3.20; 95% CI 1.38–7.40), call to emergency medical services as the first medical contact (OR 2.77; 95% CI 1.32–5.88), speech/language difficulties experienced by the patient (OR 2.21; 95% CI 1.16–4.36), and the identification of stroke symptoms by the patient (OR 1.98; 95% CI 1.03–3.82). Conclusions: The interval between the onset of symptoms and arrival at the hospital depends on certain contextual, cognitive, and behavioral factors, all of which should be considered when planning future public awareness campaigns.

Infrastructural and Knowledge Barriers to Accessing Acute Stroke Care at a Regional Tertiary Facility in Kenya

2021 ◽  
Vol 4 (1) ◽  
pp. 50-57
Author(s):  
Caroline Mithi ◽  
Jasmit Shah ◽  
Peter Mativo ◽  
Dilraj Singh Sokhi
Keyword(s):  
Acute Stroke ◽  
Public Awareness ◽  
Stroke Care ◽  
Stroke Onset ◽  
Next Of Kin ◽  
Acute Stroke Care ◽  
Cross Sectional ◽  
Stroke Treatment ◽  
Early Arrival ◽  
Cardinal Symptom

The delivery of definitive acute stroke care in Africaremains low due to prehospital barriers, and these are known to be country-specific. There have been no studies on elucidating these barriers in Kenya. Objectives: We sought to identify the nature of barriers to acute stroke care for patients presenting to our hospital in Nairobi, Kenya. Materials and Methods: We conducted a prospective cross-sectional study atour tertiary regional referral center from August 2018 to March 2019 for patients presenting with an acutestroke. We consented participants (patients or their registered next-of-kin) to fill out a questionnaire on their journey from stroke-onset to the ward bed, and about their knowledge about stroke. Results: We recruited 103 participants. Only 25.2% arrived to hospital within 3.5 h (early arrival) of stroke onset. The significant factors causing delay were:distance from hospital, traffic, visiting another hospital first, and lack of transport vehicle. Factors significantly associated ( P<.05) with early arrival were: older age, non-African ethnic origin, bystander present at stroke onset, living near (<15km) the hospital, and knowledge of stroke. Almost 80% believed stress was a major risk factor and that dizziness was a cardinal symptom. Only 50% knew of the availability of thrombolysis/thrombectomy and their roles in stroke treatment, and only 37.9% knew the correct time limits for these. Conclusions: We identified a number of prehospital barriers to reaching hospital on time for definitive stroke treatment, which have implications on the structure of emergency services for stroke in our city. Our study also revealed interesting observations on the public’s understanding about stroke, calling for a tailored public awareness campaign to improve stroke knowledge.

Abstract WP433: Factor Associated With Significant Delay in Acute Stroke Triage Process

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Mananchaya Kongmuangpuk ◽  
Usanee Fongsri ◽  
Rojana Pakdeewongse ◽  
Roongnapa Sinlapadeelerdkul ◽  
Waitayaporn Pengtong ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Fast Track ◽  
Demographic Data ◽  
Stroke Care ◽  
Chief Complaint ◽  
Acute Stroke Care ◽  
Multivariable Logistic Regression Model ◽  
Factors Associated ◽  
Presenting Symptoms ◽  
Initial Symptoms

Background: Benefit of revascularization in acute ischemic stroke declines over time. Any delay in acute stroke care contributes to poor treatment outcome. We aimed to identify factors associated with the delay in the process of acute stroke triage. Methods: All patients presented at the emergency room at the Siriraj Hospital, Mahidol University, Thailand under stroke fast track protocol (ASFP) from January 2015 to March 2017 were reviewed. Demographic data, stroke subtypes, time measures, initial NIHSS were recorded. Delay in triage was defined as either door to first physician > 10 minutes or door to activate stroke fast track > 15 minutes. Multivariable logistic regression model were performed to identify independent variables associated with triage delay. Results: A total of 1,000 patients were enrolled under ASFP with a mean age of 63.5+15.3 years and 53.9% were male. Triage delay was found in 11.2%. Factors associated with a delay in stroke triage were inaccurate presenting symptom(s) OR17.69 (95% CI 10.86, 28.82), dizziness and dysphagia as an initial presentation OR 3.26 (95% CI 1.64, 6.48) and OR 8.02 (95% CI 1.31, 49.28) respectively and uncertain chief complaint OR 3.35 (95% CI 1.56, 7.19). Conclusion: Unclear chief complaint, dizziness and vertigo as an initial symptoms and inaccurate presenting symptoms significantly associated with the delay in acute stroke triage in an emergency department. Further research is needed to clarify if strategic questioning could help nurses and ER physicians in reducing this delay.

scholarly journals Enablers of the Implementation of Tissue Plasminogen Activator in Acute Stroke Care: A Cross-Sectional Survey

PLoS ONE ◽  
2014 ◽  
Vol 9 (12) ◽  
pp. e114778 ◽  
Author(s):  
Alice Grady ◽  
Jamie Bryant ◽  
Mariko Carey ◽  
Chris Paul ◽  
Rob Sanson-Fisher
Keyword(s):  
Acute Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Tissue Plasminogen

scholarly journals Utstein recommendation for emergency stroke care

2020 ◽  
Vol 15 (5) ◽  
pp. 555-564 ◽  
Author(s):  
AG Rudd ◽  
C Bladin ◽  
P Carli ◽  
DA De Silva ◽  
TS Field ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Best Practice ◽  
Prehospital Care ◽  
Public Awareness ◽  
Stroke Care ◽  
Successful Implementation ◽  
Care Needs ◽  
Acute Stroke Care ◽  
Implementation Program ◽  
Prehospital Triage

Background Recent advances in treatment for stroke give new possibilities for optimizing outcomes. To deliver these prehospital care needs to become more efficient. Aim To develop a framework to support improved delivery of prehospital care. The recommendations are aimed at clinicians involved in prehospital and emergency health systems who will often not be stroke specialists but need clear guidance as to how to develop and deliver safe and effective care for acute stroke patients. Methods Building on the successful implementation program from the Global Resuscitation Alliance and the Resuscitation Academy, the Utstein methodology was used to define a generic chain of survival for Emergency Stroke Care by assembling international expertise in Stroke and Emergency Medical Services (EMS). Ten programs were identified for Acute Stroke Care to improve survival and outcomes, with recommendations for implementation of best practice. Conclusions Efficient prehospital systems for acute stroke will be improved through public awareness, optimized prehospital triage and timely diagnostics, and quick and equitable access to acute treatments. Documentation, use of metrics and transparency will help to build a culture of excellence and accountability.

scholarly journals A cross-sectional study of awareness regarding dog bite and its management in rural community of Maharashtra, India

2020 ◽  
Vol 7 (9) ◽  
pp. 1307
Author(s):  
Mohammed Alqwaifly
Keyword(s):  
Saudi Arabia ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Acute Stroke Care ◽  
Cross Sectional ◽  
Stroke Treatment

Background: Stroke is a major cause of morbidity and disability worldwide. However, its outcomes have improved in the last few years with advancement in acute stroke treatment, including the use of tissue plasminogen activator (t-PA) within 4.5 hours of onset, which led several international guidelines to adopt it as the standard of care. In this study, authors sought to assess the knowledge, practices, and attitudes of emergency and medicine staff in Qassim, Saudi Arabia toward acute ischemic stroke care.Methods: A quantitative observational cross-sectional study involving 148 physicians from emergency and medicine departments (only three neurologists) was conducted in three main hospitals of the Qassim region, Saudi Arabia. Information was obtained from a self-administered questionnaire. A logistic regression model was used to control for potential confounding factors.Results: Ninety-two percent of participants were aware of t-PA. Eighty-seven percent of participants thought that t-PA was an effective treatment for acute ischemic stroke. Only 20% of participants had given t-PA or participated in the use of t-PA in acute ischemic stroke. Moreover, 64% of participants believed that allowing blood pressure to remain high was the most appropriate action in the first 24 hours in acute ischemic stroke patients who presented outside the t-PA window.Conclusion: Most of the emergency and medicine staff are well informed about t-PA, but the majority of these physicians have never given t-PA or participated in the administration of t-PA to a stroke patient. The main finding here is the positive outlook among emergency and medicine physicians in Qassim toward training in acute stroke care and administering t-PA for stroke, which will positively impact patient outcomes.

Abstract T P255: QCI-NASCAR - Quality Care Improvement with Nursing-driven Acute Stroke CARe

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Julian P Yang ◽  
Sonja Stutzman ◽  
Laura Riise ◽  
Donald Jones ◽  
Amanda Dirickson ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Quality Care ◽  
Data Gathering ◽  
Stroke Care ◽  
University Hospital ◽  
Acute Stroke Care ◽  
Efficient Data ◽  
Collection Form ◽  
Care Improvement ◽  
The Impact

Objective: To observe the impact on stroke code time metrics after applying a “pit stop” model of bedside nursing for telestroke encounters. Background: Despite the recent push for target treatment times in acute stroke codes, no guidelines exist for optimizing practices specific to stroke care via telemedicine. Effective telestroke is dependent on efficient data gathering by remote staff, and lengthy metrics for real-world telestroke often preclude timely tPA treatment. By co-opting “pit stops” as inspiration, an optimized nursing workflow for telestroke can be created on the following principles: Identification of Shared Goals; Organized Urgency with the Removal of Gatekeepers; Multi-personnel, Non-Sequential Processes; Focus on Defined Staged Roles; and Empowered Engagement/Responsibility. Methods: The QCI-NASCAR protocol was implemented in Oct 2013, and data was collected prospectively on consecutive stroke code activations through Apr 2014 at St. Paul University Hospital (Dallas, TX), a telestroke spoke site. The nurse-driven protocol was reinforced by a paper checklist (i.e. “Driver Sheet”), which doubled as a data collection form. Timestamps were recorded in real time for: door time, MD at bedside, CT arrival, needle time, and/or code cancellation. The primary outcome was Door-to-CT (D2CT) times to reflect the portion of the stroke code most impacted by the nursing protocol. Results: Mean D2CT times were: all cases (n=152, 33.2 min), intervention-eligible cases (n=71, 27.0 min), and thrombolytic-eligible cases (n=57, 22.2 min). A trend for lower D2CT times and standard deviations was noted in comparing the first half of the data (n=76, 38.04 ± 58.1 min) to the second (n=77, 27.8 ± 19.1 min; p<0.05). A similar pattern was noted in the subset of intervention-eligible cases: first half (n=36, 29.4 ± 37.4 min) vs. second half (n=35, 24.3 ± 18.6 min; p<0.05). IV tPA was administered 3 times, including an institutional best door-to-needle time of 32.0 min. Conclusion: QCI-NASCAR demonstrates the feasibility of implementing a nursing-driven protocol for telestroke encounters. A larger, multi-institutional trial will demonstrate if such a protocol can significantly and reproducibly lower stroke code metrics to national guideline parameters.

scholarly journals Reduction in Acute Stroke Admissions during the COVID-19 Pandemic: Data from a National Stroke Registry

2021 ◽  
pp. 1-7
Author(s):  
Carmit Libruder ◽  
Amit Ram ◽  
Yael Hershkovitz ◽  
David Tanne ◽  
Natan M. Bornstein ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Acute Stroke ◽  
Hospital Admissions ◽  
Public Awareness ◽  
Length Of Hospital Stay ◽  
Stroke Care ◽  
Demographic Characteristics ◽  
Stroke Registry ◽  
Awareness Campaigns ◽  
Number Of Patients

<b><i>Introduction:</i></b> The COVID-19 pandemic overwhelmed health-care systems worldwide, and medical care for other acute diseases was negatively impacted. We aimed to investigate the effect of the COVID-19 outbreak on admission rates and in-hospital care for acute stroke and transient ischemic attack (TIA) in Israel, shortly after the start of the pandemic. <b><i>Methods:</i></b> We conducted a retrospective observational study, based on data reported to the Israeli National Stroke Registry from 7 tertiary hospitals. All hospital admissions for acute stroke or TIA that occurred between January 1 and April 30, 2020 were included. Data were stratified into 2 periods according to the timing of COVID-19 restrictions as follows: (1) “pre-pandemic” – January 1 to March 7, 2020 and (2) “pandemic” – March 8 to April 30, 2020. We compared the weekly counts of hospitalizations between the 2 periods. We further investigated changes in demographic characteristics and in some key parameters of stroke care, including the percentage of reperfusion therapies performed, time from hospital arrival to brain imaging and to thrombolysis, length of hospital stay, and in-hospital mortality. <b><i>Results:</i></b> 2,260 cases were included: 1,469 in the pre-COVID-19 period and 791 in the COVID-19 period. Hospital admissions significantly declined between the 2 periods, by 48% for TIA (rate ratio [RR] = 0.52; 95% CI 0.43–0.64) and by 29% for stroke (RR = 0.71; 95% CI 0.64–0.78). No significant changes were detected in demographic characteristics and in most parameters of stroke management. While the percentage of reperfusion therapies performed remained unchanged, the absolute number of patients treated with reperfusion therapies seemed to decrease. Higher in-hospital mortality was observed only for hemorrhagic stroke. <b><i>Conclusion:</i></b> The marked decrease in admissions for acute stroke and TIA, occurring at a time of a relatively low burden of COVID-19, is of great concern. Public awareness campaigns are needed as patients reluctant to seek urgent stroke care are deprived of lifesaving procedures and secondary prevention treatments.

Trends in acute stroke presentations to an emergency department: implications for specific communities in accessing acute stroke care services

2019 ◽  
Vol 95 (1123) ◽  
pp. 258-264 ◽  
Author(s):  
Sonu Bhaskar ◽  
Peter Thomas ◽  
Qi Cheng ◽  
Nik Clement ◽  
Alan McDougall ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Geographic Location ◽  
Population Group ◽  
Stroke Care ◽  
Sociodemographic Factors ◽  
Delayed Presentation ◽  
Acute Stroke Care ◽  
Prehospital Delay ◽  
Increased Risk

Background and purposeSouth Western Sydney comprises of a culturally and linguistically diverse (CALD) and lower socioeconomic status population group within the state of New South Wales. Geographic location and sociodemographic factors play important roles in access to healthcare and may be crucial in the success of time-critical acute stroke intervention. The aim of this study was to examine the trends in the delayed presentation to emergency department (ED) and identify factors associated with prehospital delay for an acute stroke/transient ischaemic attack (TIA) at a comprehensive stroke centre.MethodsPatient health-related data were extracted for stroke/TIA discharges for the period 2009–2017. Electronic medical record data were used to determine sociodemographic characteristics and prehospital factors, and their associations with delayed presentation≥4.5 hours from stroke onset were studied.ResultsDuring the 9-year period, population-adjusted stroke/TIA discharge rates increased from 540 to 676 per 100 000. A significant reduction in the proportion of patients presenting to ED<4.5 hours (56% in 2009 versus 46% in 2017, p<0.001) was observed. Younger patients aged 55–64 and 65–74 years, those belonging to Polynesia, South Asia and Mainland Southeast Asia, and those not using state ambulance as the mode of arrival to the hospital were at increased risk of prehospital delay.ConclusionsComprehensive reappraisal of educational programmes for early stroke recognition is required in our region due to delayed ED presentations of younger and specific CALD communities of stroke/TIA patients.

scholarly journals A qualitative study of clinical champions in context: Clinical champions across three levels of acute care

2018 ◽  
Vol 6 ◽  
pp. 205031211879242 ◽  
Author(s):  
Mindy E Flanagan ◽  
Laurie Plue ◽  
Kristine K Miller ◽  
Arlene A Schmid ◽  
Laura Myers ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Acute Stroke ◽  
Stroke Care ◽  
Three Dimensions ◽  
Complex Care ◽  
Acute Stroke Care ◽  
Cross Sectional ◽  
Care Processes ◽  
Veterans Affairs Medical Centers ◽  
The Right

Objectives: To compare activities and field descriptions of clinical champions across three levels of stroke centers. Methods: A cross-sectional qualitative study using quota sampling was conducted. The setting for this study was 38 acute stroke centers based in US Veterans Affairs Medical Centers with 8 designated as Primary, 24 as Limited Hours, and 6 as Stroke Support Centers. Key informants involved in stroke care were interviewed using a semi-structured approach. A cross-case synthesis approach was used to conduct a qualitative analysis of clinical champions’ behaviors and characteristics. Clinical champion behaviors were described and categorized across three dimensions: enthusiasm, persistence, and involving the right people. Results: Clinical champions at Primary Stroke Centers represented diverse medical disciplines and departments (education, quality management); directed implementation of acute stroke care processes; coordinated processes across service lines; and benefited from supportive contexts for implementation. Clinical champions at Limited Hours Stroke Centers varied in steering implementation efforts, building collaboration across disciplines, and engaging in other clinical champion activities. Clinical champions at Stroke Support Centers were implementing limited changes to stroke care and exhibited few behaviors fitting the three clinical champion dimensions. Other clinical champion behaviors included educating colleagues, problem-solving, implementing new care pathways, monitoring progress, and standardizing processes. Conclusion: These data demonstrate clinical champion behaviors for implementing changes to complex care processes such as acute stroke care. Changes to complex care processes involved coordination among clinicians from multiple services lines, persistence facing obstacles to change, and enthusiasm for targeted practice changes.

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