Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
PLoS One. 2021 Mar 25;16(3):e0247829. doi: 10.1371/journal.pone.0247829. eCollection 2021.
Previous studies have reported that early hospital arrival improves clinical outcomes in patients with acute ischemic stroke; however, whether early arrival is associated with favorable outcomes regardless of reperfusion therapy and the type of stroke onset time is unclear. Thus, we investigated the impact of onset-to-door time on outcomes and evaluated the predictors of pre-hospital delay after ischemic stroke.
Consecutive acute ischemic stroke patients who arrived at the hospital within five days of onset from September 2019 to May 2020 were selected from the prospective stroke registries of Seoul National University Hospital and Chung-Ang University Hospital of Seoul, Korea. Patients were divided into early (onset-to-door time, ≤4.5 h) and late (>4.5 h) arrivers. Multivariate analyses were performed to assess the effect of early arrival on clinical outcomes and predictors of late arrival.
Among the 539 patients, 28.4% arrived early and 71.6% arrived late. Early hospital arrival was significantly associated with favorable outcomes (three-month modified Rankin Scale [mRS]: 0-2, adjusted odds ratio [aOR]: 2.03, 95% confidence interval: [CI] 1.04-3.96) regardless of various confounders, including receiving reperfusion therapy and type of stroke onset time. Furthermore, a lower initial National Institute of Health Stroke Scale (NIHSS) score (aOR: 0.94, 95% CI: 0.90-0.97), greater pre-stroke mRS score (aOR: 1.58, 95% CI: 1.18-2.13), female sex (aOR: 1.71, 95% CI: 1.14-2.58), unclear onset time, and ≤6 years of schooling (aOR: 1.76, 95% CI: 1.03-3.00 compared to >12 years of schooling) were independent predictors of late arrival.
Thus, the onset-to-door time of≤4.5 h is crucial for better clinical outcome, and lower NIHSS score, greater pre-stroke mRS score, female sex, unclear onset times, and ≤6 years of schooling were independent predictors of late arrival. Therefore, educating about the importance of early hospital arrival after acute ischemic stroke should be emphasized. More strategic efforts are needed to reduce the prehospital delay by understanding the predictors of late arrival.
既往研究表明急性缺血性脑卒中患者早期到院可改善临床结局；然而，早期到院是否与再灌注治疗及卒中发病时间类型无关而均能带来良好结局尚不明确。因此，我们旨在探讨发病至到院时间对结局的影响，并评估缺血性卒中后院前延误的预测因素。
本研究纳入了 2019 年 9 月至 2020 年 5 月期间发病 5 天内到我院就诊的连续急性缺血性卒中患者，这些患者来自于韩国首尔国立大学医院和延世大学附属医院的前瞻性卒中登记处。患者被分为早期（发病至到院时间≤4.5 h）和晚期（>4.5 h）到院者。采用多变量分析评估早期到院对临床结局的影响以及晚期到院的预测因素。
在 539 例患者中，28.4%为早期到院，71.6%为晚期到院。早期到院与良好结局显著相关（3 个月改良 Rankin 量表[mRS]：0-2，调整优势比[aOR]：2.03，95%置信区间[CI]：1.04-3.96），且不受包括接受再灌注治疗及卒中发病时间类型在内的各种混杂因素影响。此外，较低的初始国立卫生研究院卒中量表（NIHSS）评分（aOR：0.94，95%CI：0.90-0.97）、较高的卒中前 mRS 评分（aOR：1.58，95%CI：1.18-2.13）、女性（aOR：1.71，95%CI：1.14-2.58）、发病时间不明确以及≤6 年受教育程度（aOR：1.76，95%CI：1.03-3.00 相比于>12 年受教育程度）是晚期到院的独立预测因素。
因此，发病至到院时间≤4.5 h 对于改善临床结局至关重要，而 NIHSS 评分较低、卒中前 mRS 评分较高、女性、发病时间不明确及≤6 年受教育程度是晚期到院的独立预测因素。因此，应当强调对急性缺血性卒中后早期到院重要性的教育。通过了解晚期到院的预测因素，需要采取更具战略性的措施来减少院前延误。
