Mark O'Meara Ryan, Ganas Ushira, Hendrikse Clint
Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
Afr J Emerg Med. 2022 Dec;12(4):366-372. doi: 10.1016/j.afjem.2022.07.010. Epub 2022 Aug 14.
The burden of stroke in Africa has increased in the last two decades, with the population undergoing a rapid epidemiological transition, with a rise in the incidence of stroke risk factors together with the gradual aging of the population. Evidence-based guidelines for acute stroke care are often not feasible in resource challenged settings but even when resources are available, considerable delays to definitive care exists. This study aims to describe the factors that influence time from symptom onset to hospital arrival in patients that present to a district level hospital Emergency Centre with confirmed ischaemic strokes.
A descriptive analysis was performed using a retrospective folder and database review. All adult patients with a confirmed ischaemic stroke, on Computed Tomography (CT) scan, presenting to Mitchells Plain Hospital Emergency Centre during the study period of 12 months (1 of January 2019 to 31 of December 2019), were eligible for inclusion. Data were collected from existing electronic patient databases and the time from onset of symptoms to hospital arrival was extracted from the clinical notes.
A total of 730 (2%) patients presented with a diagnosis of stroke, of which 381 (52%) were included (CT confirmed ischaemic strokes). Only 48 (13%) presented within 4.5 h of symptom onset and the median time from onset of symptoms to presentation to the hospital was 24 h (IQR 12-72 h). The majority of patients (31%) arrived via a primary public emergency medical service (EMS) call, while 29% presented directly to the hospital as self-referrals with private transport. Primary public EMS calls had the shortest call-to-hospital-arrival time (1 hour and 31 minutes), even though the median time from symptom onset to hospital arrival was still 16 h.
The median time from symptom onset to hospital arrival for patients with stroke symptoms is much longer than what evidence-based guidelines suggest. The chain of survival for emergency stroke care is only as strong as its weakest link and the data from this study suggest that improvement campaigns should target stroke education and access to care.
在过去二十年中，非洲的中风负担有所增加，人口经历了快速的流行病学转变，中风危险因素的发病率上升，同时人口逐渐老龄化。在资源有限的环境中，基于证据的急性中风护理指南往往不可行，但即使有资源，确定性治疗也存在相当大的延迟。本研究旨在描述影响确诊为缺血性中风的患者从症状发作到入院时间的因素，这些患者前往区级医院急诊科就诊。
采用回顾性病历和数据库审查进行描述性分析。在12个月的研究期间（2019年1月1日至2019年12月31日），所有经计算机断层扫描（CT）确诊为缺血性中风、前往米切尔平原医院急诊科就诊的成年患者均符合纳入标准。数据从现有的电子患者数据库中收集，从症状发作到入院的时间从临床记录中提取。
共有730名（2%）患者被诊断为中风，其中381名（52%）被纳入研究（CT确诊为缺血性中风）。只有48名（13%）患者在症状发作后4.5小时内就诊，从症状发作到入院的中位时间为24小时（四分位间距12 - 72小时）。大多数患者（31%）通过初级公共紧急医疗服务（EMS）呼叫入院，而29%的患者乘坐私人交通工具直接前往医院就诊。初级公共EMS呼叫的呼叫到入院时间最短（1小时31分钟），尽管从症状发作到入院的中位时间仍为16小时。
中风症状患者从症状发作到入院的中位时间远长于基于证据的指南所建议的时间。紧急中风护理的生存链强度取决于其最薄弱的环节，本研究数据表明，改善行动应针对中风教育和获得护理的机会。
