Pre-Hospital Delay and Associated Factors of Ischemic Stroke in Northern Mediterranean Countries: A Literature Review

Ahmed Kharbach 1 * , Majdouline Obtel 1 2, Mohamed Amine Baba 3 4, Laila Lahlou 4, Rachid Razin 1 2
More Detail
1 Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, MOROCCO
2 Laboratory of Social Medicine (Public Health, Hygiene and Preventive Medicine), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, MOROCCO
3 Laboratory of Health Sciences, National School Applied Sciences, Ibn Zohr University, Agadir, MOROCCO
4 Faculty of Medicine and Pharmacy of Agadir, University Ibn Zohr, Agadir, MOROCCO
* Corresponding Author
EUR J BASIC MED SCI, Volume 9, Issue 1, pp. 5-16. https://doi.org/10.21601/ejbms/10817
OPEN ACCESS
Download Full Text (PDF)

ABSTRACT

The emergence of new therapeutic protocols for reperfusion requires the respect of a therapeutic window which consists of an optimal admission time of 4.5 hours, and which should not exceed 6 hours according to the latest clinical trials. The objective of this narrative review of the literature is to identify the time of admission of patients arriving at emergency departments for ischemic stroke after the onset of symptoms, as well as the factors that influence it in four European countries of the Northern Mediterranean (Spain, France, Italy, and Turkey).
Twenty-two studies published between 2004 and 2018 were included. The mean pre-hospital delay ranged from 7.65 hours to 22.5 hours. The median prehospital delay ranged from 1.54 to 6.08 hours. The proportion of patients consulting after the first 3 hours ranged from 31.6 to 96.29%. Almost half of the studies (45%) associated the transport used with early admission delay. More than a third of the studies (36%) revealed an association of this delay with the destination of the first call after the signs related to the stroke was noticed. Whereas, 32% of the studies showed that vigilance (consciousness) disorders were the symptoms most related to early admission due to their severity. In addition, advanced age was implicated in 27% of the studies as a determinant contributing to a reduction of the time to arrival of patients. Besides, the lack of awareness and underestimation of symptoms was reported in 13% of the studies, constituting the main barrier affecting negatively early admission.
These findings show that the optimal therapeutic window recommended is not always respected even if in developed countries, and that ignorance about the symptoms evocative of ischemic stroke still remains in Northern Mediterranean countries. This implies that measures ought to be implemented in order to improve care in the best possible way, focusing mainly on educating and raising the awareness of the population about the signs of this disabling disease and the actions to be taken.
Keywords: Ischemic stroke, prehospital delay, associated factors, therapeutic window, Northern Mediterranean countries

CITATION

Kharbach A, Obtel M, Baba MA, Lahlou L, Razin R. Pre-Hospital Delay and Associated Factors of Ischemic Stroke in Northern Mediterranean Countries: A Literature Review. Eur J Basic Med Sci. 2019;9(1):5-16. https://doi.org/10.21601/ejbms/10817

REFERENCES

  • Koksal EK, et al. Factors associated with early hospital arrival in acute ischemic stroke patients. Neurological Sciences, 2014; 35(10): 1567-72. doi: 10.1007/s10072-014-1796-3.
  • Ruiz RG, et al. Response to Symptoms and Prehospital Delay in Stroke Patients. Is It Time to Reconsider Stroke Awareness Campaigns? J Stroke Cereb Dis, 2018; 27(3): 625-32. doi: 10.1016/j.jstrokecerebrovasdis.2017.09.036.
  • Pulvers JN, Watson JDG. If time is brain where is the improvement in prehospital time after stroke? Frontiers in neurology, 2017; 8: 617. doi: 10.3389/fneur.2017.00617.
  • Redjaline A, et al. Délais d’admission et profil des patients présentant un accident vasculaire cérébral admis aux urgences d’hôpitaux ne disposant pas d’une unité neurovasculaire Admission time and profile of patients presenting with acute stroke admitted to emergency department with no neurovascular unit. Annales françaises de médecine d’urgence, 2015; 5(5): 214-22. doi: 10.1007/s13341-015-0576-x.
  • Geffner D, et al. Delay in seeking treatment by patients with stroke: who decides, where they go, and how long it takes. Clinical neurology and neurosurgery, 2012; 114(1): 21-5. doi: 10.1016/j.clineuro.2011.08.014.
  • Pulvers JNaW, John DG. If time is brain where is the improvement in prehospital time after stroke? Frontiers in neurology, 2017; 8: 617. doi: 10.3389/fneur.2017.00617.
  • Keskin Ö, Kalemoğlu M, Ulusoy RE. A clinic investigation into prehospital and emergency department delays in acute stroke care. Medical Principles and Practice, 2005; 14(6): 408-12. doi: 10.1159/000088114.
  • Korkmaz T, et al. An evaluation of pre-admission factors affecting the admission time of patients with stroke symptoms. Turk J Emerg Med, 2010; 10(3): 106-11.
  • Maestroni A, et al. Factors influencing delay in presentation for acute stroke in an emergency department in Milan, Italy. Emergency Medicine Journal, 2008; 25(6): 340-5. doi: 10.1136/emj.2007.048389.
  • Charaa A, et al. 294 Accidents Vasculaires Cérébraux (AVC) en région centre: devenir selon les modalités de prise en charge. Journal Européen des Urgences, 2004; 17: 110. doi: 10.1016/S0993-9857(04)97282-2.
  • Denti L, et al. Pre-hospital delay as determinant of ischemic stroke outcome in an Italian cohort of patients not receiving thrombolysis. Journal of Stroke and Cerebrovascular Diseases, 2016; 25(6): 1458-66.
  • Desseigne N, et al. Quels sont les facteurs influençant les délais d’admission des patients arrivant aux urgences pour une suspicion d’accident vasculaire cérébral. La Presse Médicale, 2012; 41(11): e559-e567. doi: 10.1016/j.lpm.2012.01.041.
  • Griesser A-C, et al. Identification des facteurs qui influencent favorablement ou défavorablement le délai de la prise en charge et du traitement d’un patient victime d’un accident vasculaire cérébral (AVC).
  • Heydenreich C, et al. Évaluation des délais et des stratégies de prise en charge des accidents vasculaires cérébraux: de la régulation à la thrombolyse. Journal Européen des Urgences, 2008; 21: A27. doi: 10.1016/j.jeur.2008.03.384.
  • Joux J, et al. Prehospital transfer medicalization increases thrombolysis rate in acute ischemic stroke. A French stroke unit experience. Clinical neurology and neurosurgery, 2013; 115(9): 1583-5. doi: 10.1016/j.clineuro.2013.02.010.
  • Julié V, et al. 297 Les accidents vasculaires cérébraux (avc) aux urgences: étude épidémiologique dans la région centre (étude avc-centre). 2004; 17: 111. doi: 10.1016/S0993-9857(04)97285-8.
  • Laribi S, et al. 293 Accidents vasculaires cérébraux ischémiques et thrombolyse: les délais de prise en charge par le smur sont-ils compatibles? Journal Européen des Urgences, 2004; 17: 110. doi: 10.1016/S0993-9857(04)97281-0.
  • Luis D, et al. 296 Prise en charge des accidents vasculaires cérébraux dans 5 hôpitaux généraux d’ile de france: états des lieux et dysfonctionnement de la filière. 2004; 17: 111. doi: 10.1016/S0993-9857(04)97284-6.
  • Memis S, et al. Multiple causes for delay in arrival at hospital in acute stroke patients in Aydin, Turkey. BMC neurology, 2008; 8(1): 15. doi: 10.1186/1471-2377-8-15.
  • Palomeras E, et al. Emergency perception and other variables associated with extra‐hospital delay in stroke patients in the Maresme region (Spain). European journal of neurology, 2008; 15(4): 329-35. doi: 10.1111/j.1468-1331.2008.02082.x.
  • Ruiz RG, et al. Response to symptoms and prehospital delay in stroke patients. Is it time to reconsider stroke awareness campaigns? 2018; 27(3): 625-32.
  • Silvestrelli G, et al. Early admission to stroke unit influences clinical outcome. 2006; 13(3): 250-5. doi: 10.1111/j.1468-1331.2006.01187.x.
  • Silvestrelli G, et al. Characteristics of delayed admission to stroke unit. 2006; 28(3-4): 405-11. doi: 10.1080/10641960600549892.
  • Vidale S, et al. Reducing time delays in the management of ischemic stroke patients in Northern Italy. International journal of cardiology, 2016; 215: 431-4.
  • Vidale S, et al. Time to hospital admission and start of treatment in patients with ischemic stroke in northern Italy and predictors of delay. European neurology, 2013; 70(5-6): 349-55. doi: 10.1159/000353300.
  • Koksal EK, et al. Factors associated with early hospital arrival in acute ischemic stroke patients. 2014; 35(10): 1567-72. doi: 10.1007/s10072-014-1796-3.
  • Urimubenshi G, et al. Stroke care in Africa: A systematic review of the literature. 2018; 13(8): 797-805. doi: 10.1177/1747493018772747.
  • Fladt J, et al. Reasons for Prehospital Delay in Acute Ischemic Stroke. 2019; 8(20): e013101. doi: 10.1161/JAHA.119.013101.
  • Abraham SV, et al. Factors delaying management of acute stroke: An Indian scenario. Int J Crit Illn Inj Sci, 2017; 7(4): 224-30. doi: 10.4103/IJCIIS.IJCIIS_20_17.
  • Fekadu G, et al. Stroke event factors among adult patients admitted to Stroke Unit of Jimma University Medical Center: prospective observational study. 2019; 2019. doi: 10.21203/rs.2.9228/v1.
  • Ashraf V, et al. Factors delaying hospital arrival of patients with acute stroke. 2015; 18(2): 162. doi: 10.4103/0972-2327.150627.
  • Arulprakash N, Umaiorubahan M. Causes of delayed arrival with acute ischemic stroke beyond the window period of thrombolysis. J Family Med Prim Care. 2018; 7(6): 1248. doi: 10.4103/jfmpc.jfmpc_122_18.
  • Sim J, et al. Factors associated with the hospital arrival time in patients with ischemic stroke in Korea. 2016; 31(5): E10-E16. doi: 10.1097/JCN.0000000000000313.
  • Fang J, et al. Time interval between stroke onset and hospital arrival in acute ischemic stroke patients in Shanghai, China. 2011; 113(2): 85-8. doi: 10.1016/j.clineuro.2010.09.004.
  • Kharbach A, et al. Ischemic stroke in Morocco: a systematic review. 2019; 19(1): 1-15. doi: 10.1186/s12883-019-1558-1.
  • Kurz M, Kurz K, Farbu E, Acute ischemic stroke–from symptom recognition to thrombolysis. Acta Neurol Scand Suppl. 2013; 127: 57-64. doi: 10.1111/ane.12051.
  • Zhou Y, et al. Pre-hospital Delay after Acute Ischemic Stroke in Central Urban China: Prevalence and Risk Factors. Mol Neurobiol, 2017; 54(4): 3007-16. doi: 10.1007/s12035-016-9750-4.
  • Evenson KR, et al. A comprehensive review of prehospital and in-hospital delay times in acute stroke care. 2009; 4(3): 187-99. doi: 10.1111/j.1747-4949.2009.00276.x.
  • Zhou Y, et al. Pre-hospital delay after acute ischemic stroke in central urban China: Prevalence and risk factors. 2017; 54(4): 3007-16. doi: 10.1007/s12035-016-9750-4.
  • Kim YS, et al. Stroke awareness decreases prehospital delay after acute ischemic stroke in Korea. 2011; 11(1): 2. doi: 10.1186/1471-2377-11-2.
  • Sekoranja L, et al. Factors influencing emergency delays in acute stroke management. Swiss Med Wkly, 2009; 139(27-28): 393-9.
  • Rossnagel K, et al. Out-of-hospital delays in patients with acute stroke. 2004; 44(5): 476-83. doi: 10.1016/j.annemergmed.2004.06.019.
  • Yanagida T, et al. Causes of prehospital delay in stroke patients in an urban aging society. 2014; 5(3): 77-81. doi: 10.1016/j.jcgg.2014.02.001.
  • Dimitriou P, et al. Factors associated with delayed presentation at the emergency department in patients with acute ischemic stroke. 2019; 33(9): 1257-61. doi: 10.1080/02699052.2019.1641226.
  • Pandian JD, et al. Factors delaying admission to a hospital-based stroke unit in India. 2006; 15(3): 81-7.
  • Nkoke C, et al. Stroke mortality and its determinants in a resource-limited setting: A prospective cohort study in Yaounde, Cameroon. 2015; 358(1-2): 113-7. doi: 10.1016/j.jns.2015.08.033.
  • Jin H, et al. Factors associated with prehospital delays in the presentation of acute stroke in urban China. 2012; 43(2): 362-70. doi: 10.1161/STROKEAHA.111.623512.
  • Razzak JA, Cone DC, Rehmani R. Emergency medical services and cultural determinants of and emergency in Karachi, Pakistan. 2001; 5(3): 312-6.
  • Peyravi M, et al. An overview of shiraz emergency medical services, dispatch to treatment. 2013; 15(9): 823. doi: 10.5812/ircmj.10982.
  • Waseem H, et al. Epidemiology of major incidents: an EMS study from Pakistan. 2011; 4(1): 48. doi: 10.1186/1865-1380-4-48.
  • Jones SP, et al. Stroke knowledge and awareness: an integrative review of the evidence. 2010; 39(1): 11-22. doi: 10.1093/ageing/afp196.
  • Kim HJ, et al. Factors associated with prehospital delay for acute stroke in Ulsan, Korea. 2011; 41(1): 59-63. doi: 10.1016/j.jemermed.2010.04.001.
  • Jemaa HB, et al. Délais de prise en charge des accidents vasculaires cérébraux: Expérience de la région du centre tunisien. 2008; 37(10): 1502-3. doi: 10.1016/j.lpm.2008.05.003.
  • Nowacki P, et al. Patients’ and bystanders’ awareness of stroke and pre-hospital delay after stroke onset: perspectives for thrombolysis in West Pomerania Province, Poland. 2007; 58(3): 159-65. doi: 10.1159/000104717.
  • Chen C-H, et al. Pre-hospital and in-hospital delays after onset of acute ischemic stroke—A Hospital-based study in Southern Taiwan. 2007; 23(11): 552-9. doi: 10.1016/S1607-551X(08)70002-0.
  • Nedeltchev K, et al. Pre-and in-hospital delays from stroke onset to intra-arterial thrombolysis. 2003; 34(5): 1230-4.
  • Hong ES, et al. Factors associated with prehospital delay in acute stroke. 2011; 28(9): 790-3. doi: 10.1136/emj.2010.094425.
  • Sauser K, et al. Hospital variation in thrombolysis times among patients with acute ischemic stroke: the contributions of door-to-imaging time and imaging-to-needle time. 2014; 71(9): 1155-61. doi: 10.1001/jamaneurol.2014.1528.
  • Inatomi Y, et al. Pre-hospital delay in the use of intravenous rt-PA for acute ischemic stroke in Japan. 2008; 270(1-2): 127-32. doi: 10.1016/j.jns.2008.02.018.
  • California Acute Stroke Pilot Registry (CASPR) Investigators. Prioritizing interventions to improve rates of thrombolysis for ischemic stroke. Neurology. 2005; 64(4): 654-9. doi: 10.1212/01.WNL.0000151850.39648.51.
  • Pandian JD, et al. Knowledge of stroke among stroke patients and their relatives in Northwest India. 2006; 54(2): 152.
  • De Dominicis L, et al. What do Italians at high risk of stroke know about ischaemic stroke? A survey among a group of subjects undergoing neuro-sonographic examination. 2006; 27(1): 7-13. doi: 10.1007/s10072-006-0558-2.
  • Centers for Disease Control and Prevention (CDC). Awareness of stroke warning signs--17 states and the US Virgin Islands, 2001. MMWR Morb Mortal Wkly Rep. 2004; 53(17): 359.
  • Kharbach A, et al. Speech disorders and stroke in the Souss Massa Region in Morocco. Afr J of Health Sci. 2019; 1(1). doi: 10.5334/aogh.2885.
  • Bouckaert M, Lemmens R, Thijs V. Reducing prehospital delay in acute stroke. Nat Rev Neurol. 2009; 5(9): 477-83.
  • Faiz KW, et al. Factors related to decision delay in acute stroke. 2014; 23(3): 534-9. doi: 10.1016/j.jstrokecerebrovasdis.2013.05.007.