Objectives: Prehospital delay is a challenge for stroke treatment and the delivery of time-critical treatments. Few studies have examined secular trends in prehospital delay, and results vary. This study investigates how prehospital delay among Norwegian stroke patients has changed over the last 2 decades.
Methods: We compared time from symptom onset to admission in 2 cohorts of stroke patients admitted to Akershus University Hospital, Norway, in 1994 (n = 550) and 2012 (n = 522), and constructed predictive models for arrival within 3 hours for each cohort.
Results: More patients arrived within 3 hours of symptom onset in 2012 compared to 1994 (proportion, 47.1% versus 19.3%, P < .001), also after adjusting for age, sex, and baseline differences; odds ratio (OR) was 5.14 (95% confidence interval [CI] 3.69-7.15). Stroke severity was the only predictor examined that was independently associated with early arrival during both periods. For patients with moderate strokes the overall OR was 2.06 (95% CI 1.41-3.00) and for severe strokes 4.52 (95% CI 2.97-6.87), compared to those with mild strokes. In the 1994 cohort additional predictors of early arrival were living with others and not being admitted from nursing home.
Conclusions: Prehospital delay in Norway has decreased considerably over the last 2 decades and since the availability of time-critical treatments. However, there is still an urgent need to reduce the number of delayed admissions as a large proportion of patients continue to arrive too late to benefit from these treatments. Patients with severer strokes were predicted to have earlier arrival.
Keywords: Acute stroke; cerebrovascular disease; patient admission; prehospital delay; secular trends.
Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.