Article

Clinical Characteristics of Patients With Early Hospital Arrival After Stroke Symptom Onset

Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association (Impact Factor: 1.99). 11/2005; 14(6):272-7. DOI: 10.1016/j.jstrokecerebrovasdis.2005.07.002
Source: PubMed

ABSTRACT Identifying characteristics of early arrivers after stroke may be useful to improve delivery of acute stroke treatment. We sought to identify the clinical characteristics and outcomes of patients with ischemic stroke who present early after symptom onset using data collected from a representative sample of hospitals in the state of Georgia.
Data were obtained retrospectively from a statewide observational stroke registry from December 1, 2001, to February 28, 2002, and from February 1 to March 31, 2003. Clinical characteristics of patients with stroke arriving to the hospital within 2 hours were compared with those arriving later.
Of the 409 patients with ischemic stroke identified with a specified time of onset, 172 (42%) presented within 2 hours. Univariate analysis showed hospital arrival within 2 hours was associated with history of coronary artery disease (P = .0400), dyslipidemia (P = .0100), ambulance transport (P = .0285), stroke team consultation (P = .0070), higher National Institutes of Health Stroke Scale score (P < .0001), and lower Glasgow Coma Scale score (P = .0018). Race, sex, age, smoking history, previous stroke, myocardial infarction, congestive heart failure, prosthetic heart valve, hypertension, diabetes, and family history of stroke were not associated with arrival within 2 hours. Multivariate analysis revealed National Institutes of Health Stroke Scale score (odds ratio = 1.20, confidence interval 1.08-1.34, P = .0013) and Glasgow Coma Scale score (odds ratio = 0.84, confidence interval 0.75-0.94, P = .0027) were associated with arrival within 2 hours. Patients with stroke arriving within 2 hours had higher in-hospital mortality (13% v 4%) (P = .0284), but a higher rate of independent ambulation at discharge (55% v 37%) (P = .0419).
Early arrival after ischemic stroke symptom onset is associated with increased stroke severity, higher mortality, and better functional outcome.

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    • "In NHAMCS, ambulance patients were older and more likely to be admitted to an intensive care unit [15]. In Georgia USA, the 172/409 patients who arrived within 2 hours of symptom onset were more likely to have attended by ambulance with a greater severity of neurological deficit and inpatient mortality [19]. A prospective study across 14 tertiary hospitals in Korea showed significant associations between arrival by emergency ambulance (36% of total admissions), stroke severity, previous stroke and poorer outcome [20]. "
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