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J Korean Soc Emerg Med > Volume 17(5); 2006 > Article
Journal of The Korean Society of Emergency Medicine 2006;17(5): 431-437.
Factors in Delayed Arrival at the Emergency Department in Patients with Suspected Acute Stroke
Shin Ho Lee, Yoo Seok Park, Sung Pil Chung, In Cheol Park, Hyun Soo Chung, Sun Haeng Choi, Wen Joen Chang
1Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea. hsc104@yumc.yonsei.ac.kr
2Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea.
3Department of Emergency Medicine, Sung-Ae Hospital, Seoul, Korea.
ABSTRACT
PURPOSE:
Acute stroke is a leading cause of serious, longterm disability and mortality in Korea. Two major refractory problems limiting effective stroke management are patient delays in recognizing stroke symptoms and reluctance to take action. The purpose of this study was to evaluate the actors influencing delayed arrival at the hospital in patients with suspected acute stroke.
METHODS:
One hundred and seventy-one patients with symptoms of acute stroke who presented to the emergency department (ED) between November 2004 and April 2005 were enrolled in the study. A questionnaire prospectively surveyed by emergency medicine residents was used in evaluating patients for inclusion.
RESULTS:
Fifty-eight patients (34% of the total) arrived at the hospital within 3 hours of symptom onset. As suggested by univariate analysis, initial symptoms (mental change and speech disturbance), presence or absence of bystanders at the time of symptom onset, utilization of an emergency medical service (EMS) system and inter-hospital transfer all seemed to be associated with the time interval between detection and ED arrival. Further evaluation using multiple linear regression indicated that severity of initial neurologic symptoms, use of EMS transport, the necessity of interhospital transfer, and score on the abnormal Los Angeles Prehospital Stroke Scale (LAPSS) were statistically significant factors affecting arrival time.
CONCLUSION:
Factors that were associated with earlier ED arrival were severe initial symptoms, utilization of the EMS system, direct arrival from the site of symptom onset, and abnormal LAPSS. Therefore, continuous public education and paramedic training is required to promote early detection and delivery of patients with acute stroke to an appropriate facility.
Key words: Cerebrovascular Accident, Time Factors, Emergenics departments
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