Factors affecting prehospital delay in rural and urban patients with stroke: a prospective survey-based study in Southwe
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RESEARCH ARTICLE
Open Access
Factors affecting prehospital delay in rural and urban patients with stroke: a prospective survey-based study in Southwest Germany Matthias N. Ungerer, Loraine Busetto, Nima H. Begli, Katharina Riehle, Jens Regula and Christoph Gumbinger*
Abstract Background: Reducing prehospital delay plays an important role in increasing the thrombolysis rate in patients with stroke. Several studies have identified predictors for presentation ≤4.5 h, but few compared these predictors in urban and rural communities. We aimed to identify predictors of timely presentation to the hospital and identify possible differences between the urban and rural populations. Methods: From January to June 2017, we conducted a prospective survey of patients with stroke admitted to an urban comprehensive stroke centre (CSC) and a rural primary care centre (PCC). Predictors were identified using binary logistical regression. Predictors and patient characteristics were then compared between the CSC and PCC. Results: Overall, 459 patients were included in our study. We identified hesitation before seeking help, awareness of the existence of a time-window, type of admission and having talked about stroke symptoms with friends/ relatives who had previously had a stroke as the strongest predictors for presentation to the emergency room ≤4.5 h. Patients admitted to the rural PCC were more hesitant to seek help and less likely to contact emergency services, even though patients had comparable knowledge pertaining to stroke care concepts. Conclusions: Patients from rural areas were more likely to be hesitant to seek help and contacted the EMS less frequently, despite similar self-awareness of having a stroke. Educational campaigns should focus on addressing these disparities in rural populations. Affected patients should also be encouraged to talk about their symptoms and take part in educational campaigns. Keywords: Prehospital emergency care, Stroke, Rural communities, Rural health services, Treatment delay
Background Thrombolysis shows a time-dependent treatment effect within the therapeutic time-window of 4.5 h in stroke, although new treatment approaches, such as perfusion and MRI guided thrombolysis and thrombectomy, have extended this time-window for treatment in individual
* Correspondence: [email protected] Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
cases [1]. Avoidable prehospital delays often contribute to presentations outside of the 4.5-h time-window. Therefore, awareness and recognition of stroke symptoms and efficient prehospital management are critical for the administration of thrombolysis [2]. Patient education, emergency personnel education, advance notification of emergency rooms (ER), triage systems, simplification of validated clinical scales and teleneurology approaches have been successfully implemented to reduce
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0
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