Truong Hoa T, Nakahara Shinji, Nguyen Sam H, Le Cuong N, Shinichi Tokuno, Kuchiba Aya, Mai Ton D, Nguyen Hanh T
Faculty of Stroke and Cerebrovascular Disease, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, VNM.
Graduate School of Health Innovation, Kanagawa University of Human Service, Kawasaki, JPN.
Cureus. 2024 Nov 9;16(11):e73361. doi: 10.7759/cureus.73361. eCollection 2024 Nov.
Delayed hospital arrival lowers the proportion of patients with stroke receiving recanalization therapy and results in poor outcomes. This study investigated the factors associated with pre-hospital delays in hospital arrival after stroke onset in the Thanh Hoa Province, Vietnam.
Clinical data were collected from stroke patients within seven days of symptom onset who were prospectively registered in this study. Patients and their relatives were interviewed using a structured questionnaire about patient social demographics, address, post-stroke support actions, and stroke awareness. Pre-hospital delay in hospital arrival was dichotomized into ≤ 4.5 hours and > 4.5 hours, and multivariable logistic regression analysis was used to investigate factors associated with the delay.
Of the 328 participants analyzed, 181 (55.4%) arrived at the hospital 4.5 hours after the symptom onset. The patients' and relatives' awareness of stroke was poor, with 298 (91.4%) who had never heard about signs of stroke onset, facial drooping, arm weakness, speech difficulties, and time to call emergency service (FAST). Pre-hospital delays were longer for patients living >10 km away from a healthcare facility and those with secondary or lower education levels, with odds ratios of 2.07 and 1.99, respectively. Seeking care at a district or private hospital as the first point of healthcare or non-use of emergency medical services did not show significant associations with odds ratio and 95% CI of 1.57 (0.93-2.65).
The study revealed that most patients with stroke did not arrive at the hospital in time for recanalization therapy. Moreover, the low stroke awareness among patients and their relatives is concerning. Further research is needed to investigate the reasons for pre-hospital delays and develop targeted interventions to improve stroke awareness and reduce these delays.
延迟入院会降低接受再通治疗的中风患者比例，并导致不良后果。本研究调查了越南清化省中风发作后院前延迟入院的相关因素。
收集本研究前瞻性登记的症状发作后7天内中风患者的临床数据。使用结构化问卷对患者及其亲属进行访谈，内容包括患者社会人口统计学、地址、中风后支持行动以及中风知晓情况。将院前延迟入院分为≤4.5小时和>4.5小时，并采用多变量逻辑回归分析来调查与延迟相关的因素。
在分析的328名参与者中，181名（55.4%）在症状发作后4.5小时到达医院。患者及其亲属对中风的知晓情况较差，298名（91.4%）从未听说过中风发作的迹象、面部下垂、手臂无力、言语困难以及呼叫急救服务的时间（FAST）。居住在距离医疗机构>10公里的患者以及中学或以下教育水平的患者院前延迟时间更长，优势比分别为2.07和1.99。将区级或私立医院作为首个医疗点就诊或未使用紧急医疗服务与优势比及95%置信区间1.57（0.93 - 2.65）之间未显示出显著关联。
该研究表明，大多数中风患者未及时到达医院接受再通治疗。此外，患者及其亲属中风知晓率低令人担忧。需要进一步研究调查院前延迟的原因，并制定有针对性的干预措施以提高中风知晓率并减少这些延迟。
