A Study on Prehospital Factors Determining the Timely Arrival for Thrombolysis among Patients Presenting with Acute Ischemic Stroke at a Tertiary Care Center in South India.

BACKGROUND

Among ischemic stroke patients, prehospital delay is the most common reason for underutilization of thrombolysis.

AIMS: The study assessed prehospital factors contributing to delay and timely arrival among study participants.

SETTINGS AND

DESIGN

A cross-sectional study was carried out at the casualty department of Government Stanley Medical College and Hospital, South India.

MATERIALS AND

METHODS

We selected 212 study participants by consecutive sampling. Data were collected by interviewing patients or accompanying family members using a semistructured questionnaire.

STATISTICAL ANALYSIS: Univariate analysis was followed by multivariate logistic regression to examine prehospital factors contributing to delay and timely arrival. Follow-up of eligible study participants for thrombolysis was performed using the National Institutes of Health Stroke Scale (NIHSS) and American Heart Association (AHA)-2019 checklist.

RESULTS

The most common factors contributing to prehospital delay and timely arrival were found to be "unawareness regarding benefits of timely arrival among patients/relatives (48.7%)" and "apprehension of some serious health issue (50%)," respectively. The distance between the hospital and the place of onset of symptoms, stroke during sleep, mode of transport, National Institutes of Health Stroke Scale (NIHSS), and slurring of speech were found to have significant odds for timely arrival for intravenous thrombolysis (IVT). Among those who arrived on time (n = 60), 13 study participants could not undergo thrombolysis. The most common reason for this was refusal of thrombolysis (4, 6.7%), and other criteria, such as minor neurological deficits (4, 6.7%), rendered them ineligible for it.

CONCLUSION

The study highlights factors associated with timely arrival at the hospital and further reasons for not undergoing IVT despite timely arrival among cases of acute ischemic stroke (AIS). There is also a need to generate awareness and disseminate information on the benefits of IVT, timely arrival, and prehospital factors; provide training in stroke preparedness; and strengthen the referral system to ensure maximum eligibility and utilization.