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Late hospital arrival for thrombolysis after stroke in Southern Portugal: Who is at risk?

2019-04Journal article Restricted access
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dc.contributor.authorSobral, Sofia
dc.contributor.authorTaveira, Isabel
dc.contributor.authorSeixas, Rui
dc.contributor.authorVicente, Ana Claudia
dc.contributor.authorDuarte, Josiana
dc.contributor.authorGoes, Ana Teresa
dc.contributor.authorDuran, David
dc.contributor.authorLopes, Joao
dc.contributor.authorRita, Henrique
dc.contributor.authorNzwalo, HipĂłlito
dc.date.accessioned2020-07-24T10:52:35Z
dc.date.available2020-07-24T10:52:35Z
dc.date.issued2019-04
dc.description.abstractBackground: 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.
dc.description.versioninfo:eu-repo/semantics/publishedVersion
dc.identifier.doi10.1016/j.jstrokecerebrovasdis.2018.12.009
dc.identifier.issn1052-3057
dc.identifier.issn1532-8511
dc.identifier.urihttp://hdl.handle.net/10400.1/14380
dc.language.isoeng
dc.peerreviewedyes
dc.publisherElsevier Science
dc.subjectAcute ischemic-stroke
dc.subjectPrehospital delay
dc.subjectCare
dc.subjectManagement
dc.subjectSeeking
dc.subjectUrban
dc.titleLate hospital arrival for thrombolysis after stroke in Southern Portugal: Who is at risk?
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage905
oaire.citation.issue4
oaire.citation.startPage900
oaire.citation.titleJournal of Stroke and Cerebrovascular Diseases
oaire.citation.volume28
person.familyNameNzwalo
person.givenNameHipĂłlito
person.identifier337064
person.identifier.ciencia-id2C1F-E4F3-2C79
person.identifier.orcid0000-0002-1502-3534
person.identifier.ridAAG-3931-2020
person.identifier.scopus-author-id36057285600
rcaap.rightsrestrictedAccess
rcaap.typearticle
relation.isAuthorOfPublication287f7d4e-5ad8-4794-b526-c61d32c00446
relation.isAuthorOfPublication.latestForDiscovery287f7d4e-5ad8-4794-b526-c61d32c00446

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