Late Hospital Arrival for Thrombolysis after Stroke in Southern Portugal: Who Is at Risk?

Autor: Rui Seixas, Josiana de Oliveira Martins Duarte, João Lopes, Henrique José Barrelas Rita, Ana Teresa Loução Goes, Isabel Taveira, David Campoamor Durán, Hipólito Nzwalo, Ana Cláudia Vicente, Sofia Sobral
Rok vydání: 2018
Předmět:
Male
Health Knowledge
Attitudes
Practice
Time Factors
medicine.medical_treatment
Care
Logistic regression
Health Services Accessibility
0302 clinical medicine
Patient Admission
Risk Factors
Thrombolytic Therapy
Infusions
Intravenous
Acute ischemic stroke
Stroke
Aged
80 and over
Rehabilitation
Thrombolysis
Middle Aged
Management
Transportation of Patients
Treatment Outcome
Tissue Plasminogen Activator
Female
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Prehospital delay
Risk Assessment
Time-to-Treatment
03 medical and health sciences
Fibrinolytic Agents
medicine
Urban
Humans
Socioeconomic status
Poverty
Aged
Forward regression
Portugal
business.industry
Mean age
Odds ratio
medicine.disease
Seeking
Socioeconomic Factors
Case-Control Studies
Emergency medicine
Surgery
Acute ischemic-stroke
Neurology (clinical)
Rural Health Services
business
030217 neurology & neurosurgery
Zdroj: Repositório Científico de Acesso Aberto de Portugal
Repositório Científico de Acesso Aberto de Portugal (RCAAP)
instacron:RCAAP
ISSN: 1532-8511
Popis: Background: Delayed hospital arrival remains the main reason for the low rates of thrombolysis in eligible acute ischemic stroke (AIS) patients. The role of socioeconomic and clinical factors for the prehospital delay of AIS remains poor and has never been studied in Portugal. Objectives: Describe the socioeconomic and clinical factors leading to delayed hospital admission of AIS patients eligible to thrombolysis. Methods: A case-control study with a consecutive thrombolyzed AIS patients from 2010 to 2015. Controls were patients who did not receive thrombolysis because of late hospital arrival. Logistic regression with stepwise forward regression analysis was used to identify independent predictors of delayed admission to receive thrombolysis with intravenous tissue-type plasminogen activator (rtPA). Results: Of the 1247 patients admitted with AIS, 76 (6%) arrived on-time and received intravenous rtPA. Controls were 65.8% (146/222) of the total number of patients included in the study. Overall, the mean age was 73 years (+/- 11, 61), a minority were below 60 years, and 43.7% were women. Being beneficiary of social insertion income (odds ratio [OR]: .286; .124-.662, P = .003), not having any telephone contact (OR: .145; .039-.536, .004) or having exclusive landline (.055; .014-.210, < .001) and posterior circulation stroke (OR: .266; .087-.811, P = .020) decreased the likelihood of hospital arrive on-time rtPA. The use of prehospital ambulance services increased (OR: 6.478; 2.751-15.254, P < .001) the odds of ER on-time arrival for thrombolysis. Conclusions: Poverty, lack of stroke awareness, or difficulties in requesting immediate medical help are the main factors implicated in late-hospital admission for thrombolysis in AIS. Stroke awareness campaigns, promotion of activation of national emergency number and stroke code can increase the rate of thrombolysis. info:eu-repo/semantics/publishedVersion
Databáze: OpenAIRE
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