Zhao Yanjie, Xu Yuezhen, Fang Shuyan, Zhi Shengze, Ma Dongfei, Song DongPo, Gao Shizheng, Wu Yifan, Zhong Qiqing, Jin Changxu, Wang Rui, Sun Jiao
School of Nursing, Jilin University, Changchun, China,
School of Nursing, Xinjiang Medical University, Urumqi, China,
Neuroepidemiology. 2024 Dec 19:1-16. doi: 10.1159/000542765.
Despite decades of educational efforts, patients with acute ischemic stroke (AIS) remain delayed in seeking medical care, which becomes the greatest obstacle to the successful management of the condition.
The objective of this study was to systematically explore the incidence and influencing factors of prehospital care-seeking delay in AIS patients.
We systematically searched the PubMed, Embase, Cochrane Library, Web of Science, and Cumulative Index to Nursing and Allied Health Literature from database inception to September 30, 2023. Meta-analysis was conducted using the Stata 15.0 software package. The pooled incidence was calculated using a random-effects model. The quality of studies reporting incidence data was assessed using Joanna Briggs Institute's Critical Appraisal Checklist and Newcastle-Ottawa Scale. Subgroup analyses were performed according to study location, country income, recruitment date, and age.
Finally, 30 related articles were included, involving a total of 287,102 people. The estimated incidence of prehospital care-seeking delay was 68%, and there were differences in this incidence in different countries (p = 0.035). Meta-analysis results showed that the delay rate was highest in low-income countries (85%) and lowest in high-income countries (62%). Patients who live farther from hospitals, have a lower level of education, diabetes, hyperlipidemia, or a history of stroke are more likely to experience delays (all p < 0.05). Conversely, those who can recognize stroke symptom, perceive the severity of early symptom, understand thrombolysis treatment, atrial fibrillation, consciousness disturbance, visual disturbance, and symptom score at admission, emergency medical service use, and immediate help-seeking have a lower risk of delay (all p < 0.05).
Prehospital care-seeking delays are common among patients with AIS, especially in low-income countries. To reduce delays, it is crucial to increase public awareness of stroke symptoms, improve education levels, and optimize healthcare accessibility.
尽管经过数十年的教育努力，但急性缺血性脑卒中（AIS）患者在寻求医疗救治方面仍存在延迟，这成为该疾病成功治疗的最大障碍。
本研究的目的是系统探讨AIS患者院前就医延迟的发生率及影响因素。
我们系统检索了从数据库建立至2023年9月30日的PubMed、Embase、Cochrane图书馆、科学网和护理及相关健康文献累积索引。使用Stata 15.0软件包进行荟萃分析。采用随机效应模型计算合并发生率。使用乔安娜·布里格斯研究所的批判性评价清单和纽卡斯尔-渥太华量表评估报告发生率数据的研究质量。根据研究地点、国家收入、招募日期和年龄进行亚组分析。
最终纳入30篇相关文章，共涉及287,102人。院前就医延迟的估计发生率为68%，不同国家的这一发生率存在差异（p = 0.035）。荟萃分析结果显示，低收入国家的延迟率最高（85%），高收入国家最低（62%）。居住距离医院较远、教育水平较低、患有糖尿病、高脂血症或有卒中病史的患者更有可能出现延迟（所有p < 0.05）。相反，那些能够识别卒中症状、感知早期症状的严重性、了解溶栓治疗、房颤、意识障碍、视觉障碍以及入院时的症状评分、使用紧急医疗服务和立即寻求帮助的患者延迟风险较低（所有p < 0.05）。
院前就医延迟在AIS患者中很常见，尤其是在低收入国家。为减少延迟，提高公众对卒中症状的认识、改善教育水平并优化医疗可及性至关重要。
