Rosamond W D, Gorton R A, Hinn A R, Hohenhaus S M, Morris D L
Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC.
Acad Emerg Med. 1998 Jan;5(1):45-51. doi: 10.1111/j.1553-2712.1998.tb02574.x.
To assess the determinants of prehospital delay for patients with presumed acute cerebral ischemia (ACI) in order to provide the background necessary to develop interventions to shorten such delays.
A prospective registry of patients presenting to the ED with signs and symptoms of stroke was established at a university hospital from July 1995 to March 1996. Trained nurses performed a structured ED interview, which assessed prehospital delay and potential confounders.
The median delay (interquartile range) from symptom onset to ED arrival for all patients seeking care for stroke-like symptoms (n = 152) was 3.0 hours (1.5-7.8 hr). The median delay from symptom onset to ED arrival was less in cases where a witness first recognized that there was a serious problem than it was when the patient first identified the problem. A heightened sense of urgency by the patient about his or her symptoms, and use of 911/emergency medical services (EMS) transport were also associated with rapid arrival in the ED within 3 hours of symptom onset. After adjusting for all predictor variables in a multivariable logistic regression model, only recognition of symptoms by a witness and calling 911/EMS transport remained statistically significant.
These data suggest that future efforts to intervene on prolonged prehospital delay for patients with ACI should include strategies for the community as a whole as well as persons at risk for stroke and should reinforce the use of 911 and EMS transport.
评估疑似急性脑缺血（ACI）患者院前延误的决定因素，以便为制定缩短此类延误的干预措施提供必要背景。
1995年7月至1996年3月在一家大学医院建立了一个前瞻性登记系统，登记出现中风症状和体征并前往急诊科就诊的患者。训练有素的护士进行了结构化的急诊科访谈，评估院前延误和潜在混杂因素。
所有因类似中风症状寻求治疗的患者（n = 152）从症状发作到抵达急诊科的中位延误时间（四分位间距）为3.0小时（1.5 - 7.8小时）。与患者自己首先意识到问题相比，由目击者首先识别出存在严重问题的情况下，从症状发作到抵达急诊科的中位延误时间更短。患者对自身症状的紧迫感增强以及使用911/紧急医疗服务（EMS）转运也与症状发作后3小时内快速抵达急诊科相关。在多变量逻辑回归模型中对所有预测变量进行调整后，只有目击者对症状的识别以及拨打911/EMS转运在统计学上仍具有显著意义。
这些数据表明，未来为干预ACI患者院前延误时间延长所做的努力应包括针对整个社区以及中风高危人群的策略，并且应加强911和EMS转运的使用。
