Time to Admission in Acute Ischemic Stroke and Transient Ischemic Attack

Abstract

Background and Purpose— The effect of thrombolysis depends on the time from stroke onset to treatment and therefore also on the time when patients come to the hospital. This study was designed to analyze the variables that influence the time from symptom onset to admission (TTA) to the stroke unit. Methods— We evaluated the medical records of 615 consecutive stroke or transient ischemic attack (TIA) patients admitted to our neurological department within 48 hours after symptom onset. Results— The median TTA was 180 minutes. Referral by emergency medical services (EMS; P <0.001), high National Institutes of Health Stroke Scale (NIHSS) scores ( P <0.001), strokes in the carotid territory ( P <0.001), and strokes not attributable to small vessel disease ( P <0.001) were associated with shorter prehospital delays. The TTA was adjusted for travel times (adjTTA), and all these variables remained significantly associated with time to admission. In addition, patients with previous experience with stroke or TIA had longer adjTTA ( P =0.028). Regression analysis confirmed the independent association between referral by EMS ( P =0.010), high NIHSS scores ( P <0.001), carotid territory stroke ( P <0.001), and first-ever cerebrovascular event ( P =0.022) with shorter adjTTA. Conclusions— Factors such as NIHSS scores and stroke location influence the time to admission but, unlike referral pathways, cannot be modified. Educational programs and stroke campaigns should therefore not only teach typical and less common stroke symptoms and signs but also that EMS provides the fastest means of transportation to a stroke unit and the best chances to get treatment early.