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J Prev Med Public Health > Volume 40(2); 2007 > Article
Journal of Preventive Medicine and Public Health 2007;40(2): 130-136. doi: https://doi.org/10.3961/jpmph.2007.40.2.130
Impact of an Early Hospital Arrival on Treatment Outcomes in Acute Ischemic Stroke Patients.
Young Dae Kwon, Sung Sang Yoon, Hyejung Chang
1Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Korea.
2Department of Neurology, Kyung Hee University College of Medicine, Korea.
3Department of Health Services Management, Kyung Hee University College of Business Administration, Korea. hjchang@khu.ac.kr
ABSTRACT
OBJECTIVES: Recent educational efforts have concentrated on patient's early hospital arrival after symptom onset. The purpose of this study was to evaluate the time interval between symptom onset and hospital arrival and to investigate its relation with clinical outcomes for patients with acute ischemic stroke. METHODS: A prospective registry of patients with signs or symptoms of acute ischemic stroke, admitted to the OO Medical Center through emergency room, was established from September 2003 to December 2004. The interval betwee symptom onset and hospital arrival was recorded for each eligible patient and analyzed together with clinical characteristics, medication type, severity of neurologic deficits, and functional outcomes. RESULTS: Based on the data of 256 patients, the median interval between symptom onset and hospital arrival was 13 hours, and 22% of patients were admitted to the hospital within 3 hours after symptom onset. Patients of not-mild initial severity and functional status showed significant differences between arrival hours of 0-3 and later than 3 in terms of their functional outcomes on discharge. Logistic regression models also showed that arrival within 3 hours was a significant factor influencing functional outcome (OR=5.6; 95% CI=2.1, 15.0), in addition to patient's initial severity, old age, cardioembolism subtype, and referral to another hospital. CONCLUSIONS: The time interval between symptom onset and hospital arrival significantly influenced treatment outcome for patients with acute ischemic stroke, even after controlling for other significant clinical characteristics. The findings provided initiatives for early hospital arrival of patients and improvement of emergency medical system.
Key words: Cerebrovascular disorders; Brain ischemia; Time factors; Early intervention; Treatment outcome
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