Prehospital delay after acute stroke in Kaohsiung, Taiwan

Background and Purpose - Successful acute stroke intervention depends on early hospital presentation. Our study aimed to examine the extent of and factors associated with prehospital delays after acute stroke in Taiwan, where people are new to thrombolytic therapy for stroke. Methods - Data were prospectively collected from 196 patients admitted with acute stroke who presented to the emergency department (ED) of the study hospital within 48 hours of symptom onset before intravenous recombinant tissue plasminogen activator was approved. Prehospital delay was defined as time from symptom onset to the ED arrival. Univariate and multivariable regression analyses were conducted to evaluate factors influencing delay in ED presentation and delay in decision to seek medical help. Results - The median interval between symptom onset and decision to seek medical contact was 90 minutes; the median interval between symptom onset and ED arrival was 335 minutes. The time from symptom onset to first call for medical help accounted for 45% (95% confidence interval, 41 to 50) of the prehospital delay. Advanced age delayed the decision to seek medical help, whereas stroke severity reduced the risk for this delay. Conclusions - The time interval between symptom onset and the decision to call for medical care is far from optimal and is the underlying cause of prolonged prehospital delay. Educational efforts to reduce extent of delay are urgently needed.