School of Medicine, Shenzhen University, Shenzhen, China.
National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
BMC Health Serv Res. 2024 May 10;24(1):615. doi: 10.1186/s12913-024-11088-8.
Pre-hospital delay in China is a serious issue with unclear relevant reasons, seriously impeding the adoption of appropriate measures. Herein, we analyzed the onset-to-door time (ODT) in Chinese patients with acute ischemic stroke (AIS) and its influencing factors.
We prospectively recruited 3,459 patients with AIS from nine representative tertiary general hospitals in China between January and June 2022. Patients were divided into ODT ≤ 3 h and ODT > 3 h groups. Following single-factor analysis, binary logistic regression analysis was performed to evaluate the risk factors leading to pre-hospital delay.
In total, 763 (21.83%) patients arrived at the hospital within 3 h of onset. After adjusting for confounding factors, the risk factors for ODT were residence in rural areas (odds ratio [OR]: 1.478, 95% credibility interval [CI]: 1.024-2.146) and hospital transfer (OR: 7.479, 95% CI: 2.548-32.337). The protective factors for ODT were location of onset ≤ 20 km from the first-visit hospital (OR: 0.355, 95% CI: 0.236-0.530), transportation by emergency medical services (OR: 0.346, 95% CI: 0.216-0.555), history of atrial fibrillation (OR: 0.375, 95% CI: 0.207-0.679), moderate stroke (OR: 0.644, 95% CI: 0.462-0.901), and severe stroke (OR: 0.506, 95% CI: 0.285-0.908).
Most patients with AIS fail to reach a hospital within the critical 3-h window. The following measures are recommended to reduce pre-hospital delays: reasonable distribution of hospitals accessible to nearby residents, minimizing interhospital transfer, paying attention to patients with mild stroke, and encouraging patients to use ambulance services. Pre-hospital delays for patients can be reduced by implementing these measures, ultimately improving the timeliness of treatment and enhancing patient prognosis. This study was carried out amid the COVID-19 pandemic, which presented challenges and constraints.
中国的院前延误是一个严重的问题，其相关原因尚不清楚，严重阻碍了采取适当措施。在此，我们分析了中国急性缺血性脑卒中（AIS）患者的发病至门时间（ODT）及其影响因素。
我们前瞻性招募了 2022 年 1 月至 6 月期间中国 9 家有代表性的三级综合医院的 3459 例 AIS 患者。患者分为 ODT≤3 h 和 ODT>3 h 组。单因素分析后，采用二元逻辑回归分析评估导致院前延误的危险因素。
共有 763 例（21.83%）患者在发病后 3 h 内到达医院。调整混杂因素后，ODT 的危险因素为居住在农村地区（比值比 [OR]：1.478，95%可信区间 [CI]：1.024-2.146）和医院转院（OR：7.479，95% CI：2.548-32.337）。ODT 的保护因素为起病至首诊医院<20 km（OR：0.355，95% CI：0.236-0.530）、使用急救医疗服务转运（OR：0.346，95% CI：0.216-0.555）、心房颤动病史（OR：0.375，95% CI：0.207-0.679）、中度脑卒中（OR：0.644，95% CI：0.462-0.901）和重度脑卒中（OR：0.506，95% CI：0.285-0.908）。
大多数 AIS 患者未能在关键的 3 h 内到达医院。为减少院前延误，建议采取以下措施：合理分配附近居民可及的医院，尽量减少院内转院，关注轻度脑卒中患者，鼓励患者使用救护车服务。通过实施这些措施可以减少患者的院前延误，最终提高治疗的及时性并改善患者预后。本研究在 COVID-19 大流行期间进行，期间面临挑战和限制。
