| Institution: | 2. Department of Emergency and Internal Medicine, Stroke Care Program;2. Department of Neurology, College of Medicine, Dong-A University, Busan, Republic of Korea;1. Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Morocco;2. Laboratory of Social Medicine (Public Health, Hygiene and Preventive Medicine), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Morocco;3. Higher Institute of Nursing Professions and Health Techniques of Agadir, Morocco;4. Psychiatry Departments, Prefectural Hospital Center Inezgane Ait-Melloul, Morocco;5. Laboratory of Health Sciences Research, Ibn Zohr University, Agadir, Morocco;1. Laboratory of Biostatistics, Clinical Research and Epidemiology, Faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Rabat 10100, Morocco;2. Laboratory of Social Medicine (Public Health, Hygiene and Preventive Medicine), Faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Rabat 10100, Morocco;3. Laboratory of Community Medicine, Preventive Medicine, Public Health and Hygiene, Faculty of Medicine and Pharmacy of Agadir, Ibn Zohr University, Agadir 80060, Morocco;4. High Institute of Nursing Professions and Technical Health, Agadir, Morocco;1. Neurology Department, Faculty of Medicine, Cairo University, Egypt;2. Neurology Department, Faculty of Medicine, Beni-Suef University, Egypt;3. Neurology Department, Faculty of Medicine, Tanta University, Egypt;4. Neurology Department, Faculty of Medicine, Assiut University, Egypt;5. Public Health and Community Medicine Department, Faculty of Medicine, Cairo University, Egypt |
| Abstract: | ObjectivesThis study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco.Patients and methodsAn observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department.ResultsA total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6 hours (IQR, 4–16). Multiple regression analysis showed that illiteracy (OR 38.58; CI95%: 3.40–437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI95%: 1.57–80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI95%: 0.01–0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI95%: 0.00–0.36), and direct admission without reference (OR 0.005; CI95%: 0.00–0.07), were independently associated with late arrival (> 4.5 hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI95%: 4.37–138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI95%: 0.03–0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI95%: 0.00–0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI95%: 0.03–0.80), distance between 50 and 100 km (OR 10.16; CI95%: 1.16–89.33), and direct admission without reference (OR 0.03; CI95%: 0.00–0.14), were independently associated with late arrival (> 6 hours) of patients with acute ischemic stroke.ConclusionPatient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies. |
