Factors delaying hospital arrival after acute stroke in southern Taiwan.

BACKGROUND: Acute stroke management emphasizes prompt recognition of symptoms and early medical attention. The effectiveness of stroke treatment is highly dependent on amount of time lapsed between onset of symptoms and treatment. In this study, factors that delayed seeking medical attention after stroke in southern Taiwan were explored.
METHODS: This was a prospective one-center study in which information was collected from patients who arrived at the emergency department of the study hospital within 48 hours after stroke onset. All the data were categorized into arrival time less than 2 hours (T < 2 hours) and from 2 to 48 hours (T = 2-48 hours) after stroke onset.
RESULTS: There were 789 stroke patients screened and 197 (25%) of them fulfilled the inclusion criteria. Among the 197 patients, 52 (26%) arrived at the study hospital within 2 hours of stroke (median, 75 minutes) and 145 (74%) arrived between 2-48 hours (median, 575 minutes). Among patients with T = 2-48 hours, 47 (24%) patients initially sought medical attention at other hospitals or clinics within 2 hours. The factors associated with T = 2-48 hours included interhospital transfer, location of stroke onset, first aid at outpatient clinic, and lack of awareness of emergent medical help for stroke.
CONCLUSION: Significant prehospital delays for stroke patients exist in Taiwan. The implementation of well designed, effective public health programs, coordination of stroke centers within the community hospitals, and effective emergent medical service system are needed to minimize the time to evaluation and treatment of stroke. Because of the high population density and the high incidence of stroke in Taiwan, the programs mentioned above could have a major impact on improving the care of stroke patients.