From the Department of Emergency Medical Service, College of Health and Nursing, Kongju National University, Kongju, Korea.
Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Stroke Cerebrovasc Dis. 2021 Jan;30(1):105426. doi: 10.1016/j.jstrokecerebrovasdis.2020.105426. Epub 2020 Nov 9.
The poor prognosis of acute stroke may be largely attributed to delays in treatment. Emergency medical services (EMS) usage is associated with a significant reduction in the delay in stroke treatment. The aims of this study were to identify factors associated with the delay in EMS activation for patients with acute stroke.
This study was conducted at 26 Fire Safety Centers in five districts of Seoul, Korea. Patients with acute stroke transferred by EMS and admitted to a tertiary referral hospital from January 2014 to December 2018 were enrolled. In this cross-sectional study, the dependent variable was the time from stroke onset to EMS activation time. Patients were divided into two groups, onset-to-alarm time ≤ 30 min and onset-to-alarm time > 30 min, and previously collected patient data were analyzed. We performed logistical regression analyses of characteristics differing significantly between groups.
Out of 480 patients, 197 (41%) had onset-to-alarm times > 30 min. Significant variables in the logistical analysis were alert mental state (adjusted odds ratio [aOR]: 2.77; 95% confidence interval [CI]: 1.31-6.13), pre-stroke mRS ≥ 2 (aOR: 2.46; 95% CI: 1.26-4.95), onset occurrence at private space (aOR: 2.31; 95% CI: 1.23-4.41), recognizing symptoms between 0 and 8 am (aOR: 2.30; 95% CI: 1.25-4.31), ischemic stroke (aOR: 1.88; 95% CI: 1.04-3.43), and witnessed by others (aOR: 0.32; 95% CI: 0.18-0.55).
Delay in EMS activation for acute stroke cases is possibly related to difficult situations to recognize stroke symptoms, such as alert mental state, pre-stroke mRS ≥ 2, onset occurrence at private space, recognizing symptoms between 0 and 8 am, and unwitnessed by others.
急性中风的预后不良可能在很大程度上归因于治疗的延迟。紧急医疗服务（EMS）的使用与中风治疗延迟的显著减少有关。本研究的目的是确定与急性中风患者 EMS 激活延迟相关的因素。
本研究在韩国首尔五个区的 26 个消防安全中心进行。从 2014 年 1 月至 2018 年 12 月，因急性中风通过 EMS 转移并入住三级转诊医院的患者被纳入研究。在这项横断面研究中，因变量为中风发作至 EMS 激活时间。患者被分为两组，发作至报警时间≤30 分钟和发作至报警时间>30 分钟，并分析了之前收集的患者数据。我们对两组间差异有统计学意义的特征进行了逻辑回归分析。
在 480 名患者中，有 197 名（41%）的发作至报警时间>30 分钟。逻辑分析中的显著变量为警觉的精神状态（调整后的优势比[aOR]：2.77；95%置信区间[CI]：1.31-6.13）、卒中前 mRS≥2（aOR：2.46；95% CI：1.26-4.95）、在私人空间发作（aOR：2.31；95% CI：1.23-4.41）、在 0 点至 8 点之间识别症状（aOR：2.30；95% CI：1.25-4.31）、缺血性中风（aOR：1.88；95% CI：1.04-3.43）和无他人见证（aOR：0.32；95% CI：0.18-0.55）。
急性中风患者 EMS 激活延迟可能与难以识别中风症状有关，如警觉的精神状态、卒中前 mRS≥2、在私人空间发作、在 0 点至 8 点之间识别症状和无他人见证。
