Iguchi Yasuyuki, Wada Kuniyasu, Shibazaki Kensaku, Inoue Takeshi, Ueno Yuji, Yamashita Shinji, Kimura Kazumi
Stroke Center, Department of Stroke Medicine, Kawasaki Medical School, Kurashiki.
Intern Med. 2006;45(7):447-51. doi: 10.2169/internalmedicine.45.1554. Epub 2006 May 1.
Treatment for acute ischemic stroke should be administered as soon as possible after symptom onset. The aim of this study was to investigate whether or not the patient's and bystander's first impression at stroke onset was associated with hospital arrival time.
To investigate the factors influencing the prehospital delay, we prospectively interviewed consecutive stroke patients and bystanders about their first impression at the stroke onset and assessed the methods of transportation, and clinical characteristics. Early arrival was defined as a hospital arrival of within 2 h from stroke onset.
One hundred thirty patients were enrolled: 82% were ischemic stroke and 18% were cerebral hemorrhage. The median interval between symptom onset and the hospital arrival was 7.5 h and 30% of patients presented within 2 h of stroke onset. First impression of stroke (odds ratios [OR] 4.56, 95% confidence interval [CI] 1.54-13.5, p=0.006), presence of consciousness disturbance (OR 4.29, CI 1.39-13.3, p=0.011), arrival through other facilities (OR 0.25, CI 0.08-0.76, p=0.015), a history of diabetes (OR 0.23, CI 0.06-0.80, p=0.028) and nocturnal onset (OR 0.19, CI 0.04-0.88, p=0.042) independently contributed to the early arrival.
The first impression of patients and bystanders at stroke onset is important in order to reach hospital earlier in Japan. Public educational systems such as those, which advertise stroke warning signs, are necessary.
急性缺血性卒中的治疗应在症状发作后尽快进行。本研究的目的是调查患者及旁观者在卒中发作时的第一印象是否与到达医院的时间有关。
为了调查影响院前延误的因素，我们前瞻性地连续采访了卒中患者及其旁观者，询问他们在卒中发作时的第一印象，并评估了交通方式和临床特征。早期到达定义为卒中发作后2小时内到达医院。
共纳入130例患者：82%为缺血性卒中，18%为脑出血。症状发作至到达医院的中位间隔时间为7.5小时，30%的患者在卒中发作后2小时内就诊。卒中的第一印象（比值比[OR]4.56，95%置信区间[CI]1.54 - 13.5，p = 0.006）、意识障碍的存在（OR 4.29，CI 1.39 - 13.3，p = 0.011）、通过其他医疗机构到达（OR 0.25，CI 0.08 - 0.76，p = 0.015）、糖尿病史（OR 0.23，CI 0.06 - 0.80，p = 0.028）和夜间发作（OR 0.19，CI 0.04 - 0.88，p = 0.042）独立地影响早期到达。
在日本，患者及旁观者在卒中发作时的第一印象对于更早到达医院很重要。有必要开展公共教育系统，比如宣传卒中警示信号的系统。
