A clinic investigation into prehospital and emergency department delays in acute stroke care

Objective: The aim of our study was to investigate the factors which cause prehospital and emergency department (ED) delays in acute stroke care.

Subjects and methods: We prospectively studied 229 acute stroke patients (median age: 71 +/- 19 years, 90 female and 139 male) who presented to the ED of the Gulhane Military Teaching Hospital, Istanbul, Turkey. Prehospital delay was defined as time from symptom onset to arrival at the ED. Emergency delay was defined as time from initial examination in the ED to arrival at the Neurology Intensive Care Unit.

Results: The median interval of prehospital and emergency delays were 92.66 and 53 min, respectively. The major cause of the prehospital delay was the time from symptom onset to first call for medical help (68.21 min, 73.93%, beta coefficients: 0.99; p < 0.001), and the major cause of the ED delay was waiting for the neurological consultation (21.28 min, 39.6%), beta coefficients: 0.03; p < 0.001).

Conclusion: The results indicate that prehospital and ED delays are due to late decision to seek medical care and delayed neurological consultation. Hence, educational campaigns are needed to increase public awareness of stroke signs and the necessity of calling emergency services immediately when persons are suffering a possible stroke. Equally, ED physicians need to be trained in the recognition of symptoms and signs of acute stroke and the necessity for rapid neurological evaluation.