Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco; Laboratory of Social Medicine (Public Health, Hygiene and Preventive Medicine), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
Rev Epidemiol Sante Publique. 2021 Nov;69(6):345-359. doi: 10.1016/j.respe.2021.03.010. Epub 2021 Jun 17.
This study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco.
An observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department.
A total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6hours (IQR, 4-16). Multiple regression analysis showed that illiteracy (OR 38.58; CI: 3.40-437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI: 1.57-80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI: 0.01-0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI: 0.00-0.36), and direct admission without reference (OR 0.005; CI: 0.00-0.07), were independently associated with late arrival (>4.5hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI: 4.37-138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI: 0.03-0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI: 0.00-0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI: 0.03-0.80), distance between 50 and 100km (OR 10.16; CI: 1.16-89.33), and direct admission without reference (OR 0.03; CI: 0.00-0.14), were independently associated with late arrival (>6hours) of patients with acute ischemic stroke.
Patient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.
本研究旨在评估摩洛哥苏斯马萨地区医院中心缺血性脑卒中患者的院前延误情况，并确定与患者延迟就诊相关的因素。
这是一项 2019 年 3 月至 9 月在苏斯马萨地区医院中心进行的观察性、前瞻性、横断面研究。该中心是一家公立医院。我们向缺血性脑卒中患者及其家属或其他目击者发放问卷，并从病历中收集临床和辅助检查数据。采用单因素和多因素逻辑回归分析确定与急诊科延迟就诊相关的因素。
共纳入 197 名患者和 197 名目击者，均符合研究标准。症状发作至入院的中位时间为 6 小时（IQR，4-16）。多因素回归分析显示，不识字（OR 38.58；95%CI：3.40-437.27）、等待症状消失（患者行为）（OR 11.24；95%CI：1.57-80.45）、决定直接去医院（患者行为）（OR 0.07；95%CI：0.01-0.57）、目击者知晓卒中是一种需要在有限治疗窗口内紧急治疗的疾病（OR 0.005；95%CI：0.00-0.36）以及未经转诊直接入院（OR 0.005；95%CI：0.00-0.07）与急性缺血性脑卒中患者的延迟就诊（>4.5 小时）独立相关。此外，不识字（OR 24.62；95%CI：4.37-138.69）、眩晕和平衡或协调障碍（OR 0.14；95%CI：0.03-0.73）、亲属知晓卒中是一种需要紧急治疗且治疗时间窗有限的疾病（OR 0.03；95%CI：0.00-0.22）、呼叫救护车（亲属行为）（OR 0.16；95%CI：0.03-0.80）、距离 50-100 公里（OR 10.16；95%CI：1.16-89.33）以及未经转诊直接入院（OR 0.03；95%CI：0.00-0.14）与急性缺血性脑卒中患者的延迟就诊（>6 小时）独立相关。
患者行为、目击者知识以及直接将患者送往卒中治疗的合格医院是潜在的可改变因素，有助于缩短发病至就诊时间，从而提高急性卒中治疗的实施率。
