Acute Stroke: Delays to Presentation and Emergency Department Evaluation

Byline: Rashmi Kothari, Edward Jauch, Joseph Broderick, Thomas Brott, Laura Sauerbeck, Jane Khoury, Tiepu Liu Abstract: Study objective: To document prehospital and inhospital time intervals from stroke onset to emergency department evaluation and to identify factors associated with presentation to the ED within 3 hours of symptom onset, the current time window for thrombolytic therapy. Methods: Patients admitted through the ED with a diagnosis of stroke were identified through admitting logs. Time intervals were obtained from EMS runsheets and ED records. Information regarding first medical contact, education, and income was obtained by patient interview. Baseline variables were analyzed to assess association with ED arrival within 3 hours of symptom onset; variables significant on univariate analysis were placed in a multivariable model. Results: There were 151 stroke patients (59% white and 41% black). Time of stroke onset and time to ED arrival were documented for 119 patients (79%). The median time from stroke onset to ED arrival was 5.7 hours; 46 patients (30%) presenting within 3 hours. Of those with times recorded, the median time from stroke onset to EMS arrival was 1.7 hours. Multivariable logistic regression identified use of EMS (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.3 to 12.1) and white race (OR, 3.5; 95% CI, 1.3 to 10) as being independently associated with ED arrival within 3 hours of symptom onset. Median time from ED arrival to physician evaluation was 20 minutes. Median time from ED arrival to computed tomographic evaluation was 72 minutes. When patients were asked the main reason they sought medical attention, 40% (60/141) of those able to be interviewed said that they themselves did not decide to seek medical attention, but rather a friend or family member told them they should go to the hospital. Conclusion: The median time from stroke onset to ED evaluation was 5.7 hours, with almost a third of patients presenting within 3 hours. Use of EMS and white race were independently associated with arrival within 3 hours. [Kothari R, Jauch E, Broderick J, Brott T, Sauerbeck L, Khoury J, Liu T: Acute stroke: Delays to presentation and emergency department evaluation. Ann Emerg Med January 1999;33:3-8.] Author Affiliation: From the Departments of Emergency Medicine,.sup.* Neurology,.sup.a and Environmental Health,.sup.As. University of Cincinnati Medical Center Cincinnati, OH Article History: Received 20 April 1998; Revised 16 July 1998; Accepted 29 July 1998 Article Note: (footnote) [star] Supported by a Young Investigators Award from the American Heart Association, Ohio Affiliate (SW-93944-YI)., [star][star] Address for reprints: Rashmi Kothari, MD, Department of Emergency Medicine, University of Cincinnati, PO Box 670769,Cincinnati, OH 45267-0769;E-mail rashmikant.kothari@uc.edu. , a 0196-0644/99/$8.00 + 0, aa 47/1/94119