RT Journal Article
SR Electronic
T1 Analysis of prehospital delay in acute ischaemic stroke and its influencing factors: a multicentre prospective case registry study in China
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP svn-2024-003535
DO 10.1136/svn-2024-003535
A1 Su, Ying
A1 Qi, Wenwei
A1 Yu, Yanni
A1 Zhu, Jiaqian
A1 Shi, Xin
A1 Wu, Xiaohong
A1 Chi, Feng
A1 Xia, Runyu
A1 Qin, Limin
A1 Cao, Liming
A1 Yang, Yan
A1 Liu, Qin
A1 Peng, Xiaoxiang
A1 Huang, Guobing
A1 Chen, Jinyan
A1 Xue, Yidong
A1 Guan, Wenbiao
A1 Gao, Dan
A1 Ye, Bin
A1 Ren, Lijie
YR 2025
UL http://svn.bmj.com/content/early/2025/03/14/svn-2024-003535.abstract
AB Background Prehospital delay in acute ischaemic stroke (AIS) remains prevalent in China. We aimed to assess the status of the onset-to-door time (ODT) in AIS and analyse its influencing factors.Methods Data were collected from a prospective multicentre hospital-based registry (China National Cerebrovascular Disease Prevention and Control Project Management Special Database) of patients with AIS involving 21 hospitals across different economic and geographical regions in China in 2022. The Mann-Whitney U test or t-test was used for between-group comparisons. Factors influencing ODT ≤3 hours were analysed using a binary logistic regression model.Results Of the included 12 484 patients (attended middle school or below, 69.2%), females had a higher illiteracy rate (13.1%) than males (4.8%); 94.8% were living with others at illness onset; 22.5% of patients/family members were aware of the stroke emergency map (SEM, but only 7.3% were transported by SEM; 76.8% lived within 20 km of the first visited hospital. Significant differences occurred in modes of arrival at hospitals among cities of different sizes (χ²=74.882, p<0.001). Being in a medium-sized (OR 0.65, 95% CI 0.50 to 0.86); large (OR 0.61, 95% CI 0.47 to 0.79) or extralarge city (OR 0.60, 95% CI 0.46 to 0.78); experiencing cardiogenic embolism (OR 0.65, 95% CI 0.50 to 0.86) or stroke of undetermined aetiology (OR 0.69, 95% CI 0.52 to 0.92); stroke onset between 18:00 and 23:59 (OR 0.71, 95% CI 0.60 to 0.85); distance <20 km from onset location to the hospital (OR 0.47, 95% CI 0.41 to 0.54); being transported by SEM (OR 0.31, 95% CI 0.26 to 0.36) and having initial National Institutes of Health Stroke Scale scores of 5–15 (OR 0.63, 95% CI 0.57 to 0.71) or 16–42 (OR 0.32, 95% CI 0.27 to 0.39) were independent factors favouring ODT ≤3 hours. Conversely, being transferred between hospitals during transportation (OR 3.31, 95% CI 2.66 to 4.14); experiencing wake-up stroke (OR 2.00, 95% CI 1.67 to 2.38); symptom-onset including dizziness (OR 1.28, 95% CI 1.10 to 1.47) and prestroke modified Rankin scale (mRS) score of 2–3 (OR 1.58, 95% CI 1.30 to 1.92) or 4–5 (OR 1.48, 95% CI 1.02 to 2.15) tended to indicate ODT >3 hours.Conclusions Urban scale, stroke type, onset time, distance from initial location to the first hospital visit, transportation method, stroke symptoms, prestroke mRS score and stroke severity significantly influenced prehospital delay. Our findings can facilitate the development of targeted policies.Data are available on reasonable request.