Regional disparities in prehospital delay of acute ischemic stroke: The Korean Stroke Registry.

Autor:	Lee EJ; Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.; Institute of Public Health and Care, Seoul National University Hospital, Seoul, Republic of Korea., Jeong HY; Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea., Kim J; Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea., Park NH; Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea., Kang MK; Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea., Lee D; Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu-Si, Republic of Korea., Kim J; Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-Si, Republic of Korea., Jung YH; Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Republic of Korea., Yu S; Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea., Kim WJ; Department of Neurology, Ulsan University Hospital, Ulsan, Republic of Korea., Cho HJ; Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea., Lee K; Department of Neurology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea., Park TH; Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea., Oh MS; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea., Lee JS; Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea., Kim JT; Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea., Yoon BW; Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu-Si, Republic of Korea., Park JM; Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu-Si, Republic of Korea., Bae HJ; Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea., Jung KH; Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Jazyk:	angličtina
Zdroj:	European stroke journal [Eur Stroke J] 2024 Dec; Vol. 9 (4), pp. 1063-1073. Date of Electronic Publication: 2024 May 17.
DOI:	10.1177/23969873241253670
Abstrakt:	Background: Late hospital arrival keeps patients with stroke from receiving recanalization therapy and is associated with poor outcomes. This study used a nationwide acute stroke registry to investigate the trends and regional disparities in prehospital delay and analyze the significant factors associated with late arrivals. Methods: Patients with acute ischemic stroke or transient ischemic attack between January 2012 and December 2021 were included. The prehospital delay was identified, and its regional disparity was evaluated using the Gini coefficient for nine administrative regions. Multivariate models were used to identify factors significantly associated with prehospital delays of >4.5 h. Results: A total of 144,014 patients from 61 hospitals were included. The median prehospital delay was 460 min (interquartile range, 116-1912), and only 36.8% of patients arrived at hospitals within 4.5 h. Long prehospital delays and high regional inequality (Gini coefficient > 0.3) persisted throughout the observation period. After adjusting for confounders, age > 65 years old (adjusted odds ratio [aOR] = 1.23; 95% confidence interval [CI], 1.19-1.27), female sex (aOR = 1.09; 95% CI, 1.05-1.13), hypertension (aOR = 1.12; 95% CI, 1.08-1.16), diabetes mellitus (aOR = 1.38; 95% CI, 1.33-1.43), smoking (aOR = 1.15, 95% CI, 1.11-1.20), premorbid disability (aOR = 1.44; 95% CI, 1.37-1.52), and mild stroke severity (aOR = 1.55; 95% CI, 1.50-1.61) were found to independently predict prehospital delays of >4.5 h. Conclusion: Prehospital delays were lengthy and had not improved in Korea, and there was a high regional disparity. To overcome these inequalities, a deeper understanding of regional characteristics and further research is warranted to address the vulnerabilities identified. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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