Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China.
School of First Clinical Medical, Lanzhou University, Lanzhou, Gansu, 730000, China.
Neurosurg Rev. 2024 May 3;47(1):202. doi: 10.1007/s10143-024-02436-7.
Determine the prevalence and influencing factors of patient delay in stroke patients and explore variation in prevalence by country and delayed time.
PubMed, The Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Database (CBM), Weipu database, and Wanfang database were comprehensively searched for observational studies from inception to April, 2023. The pooled prevalence, odds ratio (OR), and 95% confidence intervals (CI) were calculated with Stata 16.0 software.
In total, 2721 articles were screened and data from 70 studies involving 85,468 subjects were used in meta-analysis. The pooled prevalence of patient delay in stroke patients was 59% (95% CI, 0.54-0.64). The estimates of pooled prevalence calculated for African, Asian, and European patient delay in stroke patients were 55% (0.29-0.81), 61% (0.56-0.66), and 49% (0.34-0.64).According to the patient delay time, the prevalence of 6 h, 5 h, 4.5 h, 3.5 h, 3 h and 2 h were 54% (0.47-0.61), 73% (0.61-0.86), 60% (0.49-0.71), 81% (0.68-0.93), 52% (0.42-0.62), 63% (0.19-1.07). Distance from the place of onset to the hospital > 10 km [OR=2.49, 95%CI (1.92, 3.24)], having medical insurance [OR = 0.45, 95%CI (0.26,0.80)], lack of stroke-related knowledge [OR = 1.56, 95%CI (1.08,2.26)], education level below junior high school [OR = 1.69, 95%CI (1.22,2.36)], non-emergency medical services (Non-EMS) [OR = 2.10, 95%CI (1.49,2.97)], living in rural areas [OR = 1.54, 95%CI (1.15,2.07)], disturbance of consciousness [OR = 0.60, 95%CI (0.39,0.93)], history of atrial fibrillation [OR = 0.53, 95%CI (0.47,0.59)], age ≥ 65 years [OR = 1.18, 95%CI (1.02,1.37)], National institutes of health stroke scale (NIHSS) ≤ 4 points [OR= 2.26, 95%CI (1.06,4.79)]were factors for patient delay in stroke patients.
The prevalence of patient delay in stroke patients is high, we should pay attention to the influencing factors of patient delay in stroke patients and provide a theoretical basis for shortening the treatment time of stroke patients.
确定卒中患者的就诊延迟发生率及其影响因素，并探讨其在不同国家和延迟时间的差异。
从建库至 2023 年 4 月，全面检索 PubMed、The Cochrane Library、Embase、Web of Science、中国知网（CNKI）、中国生物医学文献数据库（CBM）、维普数据库和万方数据库，纳入观察性研究。采用 Stata 16.0 软件计算汇总患病率、比值比（OR）及其 95%置信区间（CI）。
共筛选出 2721 篇文献，最终纳入 70 项研究，共涉及 85468 例患者。卒中患者的就诊延迟发生率为 59%（95%CI：0.54-0.64）。对非洲、亚洲和欧洲的卒中患者就诊延迟发生率进行估算，结果分别为 55%（0.29-0.81）、61%（0.56-0.66）和 49%（0.34-0.64）。按照就诊延迟时间划分，6 h、5 h、4.5 h、3.5 h、3 h 和 2 h 的发生率分别为 54%（0.47-0.61）、73%（0.61-0.86）、60%（0.49-0.71）、81%（0.68-0.93）、52%（0.42-0.62）、63%（0.19-1.07）。起病至医院的距离>10 km [OR=2.49，95%CI（1.92，3.24）]、有医疗保险[OR=0.45，95%CI（0.26，0.80）]、缺乏卒中相关知识[OR=1.56，95%CI（1.08，2.26）]、教育程度低于初中[OR=1.69，95%CI（1.22，2.36）]、未使用急救医疗服务（Non-EMS）[OR=2.10，95%CI（1.49，2.97）]、居住在农村地区[OR=1.54，95%CI（1.15，2.07）]、意识障碍[OR=0.60，95%CI（0.39，0.93）]、心房颤动史[OR=0.53，95%CI（0.47，0.59）]、年龄≥65 岁[OR=1.18，95%CI（1.02，1.37）]、NIHSS 评分≤4 分[OR=2.26，95%CI（1.06，4.79）]是卒中患者就诊延迟的影响因素。
卒中患者的就诊延迟发生率较高，应关注卒中患者就诊延迟的影响因素，为缩短卒中患者的治疗时间提供理论依据。
