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Administration of IV tissue plasminogen activator

(tPA) within 4.5 hour are the proven treatment for

acute ischemic stroke. Hence, early hospital arrival is

important to improve outcome of patients.

INTRODUCTION

OBJECTIVES

The time interval between stroke onset and hospital arrival

within 3 hours interval was observed in less than one third of

our patients with acute cerebral ischemic stroke. Patients

with more severe stroke were alarmingly associated with a

longer time to hospital. Further studies to look at reasons

for delay in hospital presentation after a stroke and

developing a national level educational program aimed at

shortening arrival time is timely

Stroke outcome with time between stroke onset and hospital arrival

To examine the relationship between time interval of

stroke onset and hospital arrival (time-to hospital), and

stroke severity and outcome in acute ischemic stroke

patients at Malaysia

RESULT

CONCLUSION

1Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia, 2 Pfizer Malaysia, Kuala Lumpur, Malaysia 3Hospital Seberang Jaya, Pulau Pinang, Malaysia, 4 Hospital Kuala Lumpur, Kuala Lumpur, Malaysia,

5 Universiti Putra Malaysia, Kuala Lumpur, Malaysia

Aziz, Z1; Lee, YL 2 ; Sidek.NN 1; Looi, I3; Hanip M4, Hamidon B5

Time interval (stroke onset and hospital arrival)

was associated with severe stroke outcome among

acute ischemic stroke patients

METHOD

Characteristic

Time between stroke onset and hospital arrival

P value

Within 3

hour(n=1290)

Within 4 - 6

hours (n=594)

Within 6 hours

(n=2593)

n % n % n %

Age, mean

(SD)

62.8(12.2)

63.3(12.0)

63.3(12.3) 0.37

Gender

Male

Female

770

520

59.7

40.3

315

279

53.0

47.0

1406

1187

54.2

45.8

0.002

Ethnicity

Malay

Chinese

Indian

1076

139

40

85.7

11.1

3.2

523

38

17

90.5

6.6

2.9

2311

179

56

90.8

7.0

2.2

<0.001

Co morbidity

Hypertension

Diabetes Hyperlipidemia

Family history

of stroke

Heart disease

906

547

370

98

215

70.2

42.4

28.7

7.6

16.7

449

288

217

43

97

75.6

48.5

36.5

7.2

16.3

1890

1263

881

190

322

72.9

48.7

34.0

7.3

12.4

0.042

0.001

<0.001 0.94

<0.001

Stroke

location

Hemispheric

Cerebellum

Brainstem

477

15

52

87.7

2.8

9.6

250

11

19

89.3

3.9

6.8

989

41

106

87.1

3.6

9.3

0.56

70.2

42.4

28.7

7.6

16.7

Outcome

Time between stroke onset and hospital arrival

P value

Within 3

hour(n=1290)

Within 4 - 6

hours (n=594)

Within 6 hours

(n=2593)

n % n % n %

NIHSS

Mild (0-4)

Moderate

(5-20)

Severe (>20)

419

495

106

41.1

48.5

10.4

172

188

81

39.0

42.6

18.4

837

859

222

43.6

44.8

11.6

<0.001

LOS, mean (SD)

4.7(4.8)

4.4(4.4)

4.3(4.2)

0.075

MRS

Mild (0-2)

Moderate(3-4)

Severe(5)

476

520

165

37.3

40.7

12.9

165

275

88

27.8

46.3

14.8

817

12123

333

31.6

46.9

12.9

<0.001

Complication

Stroke associated pneumonia

Gastrointestinal

bleed

Sepsis

Cardiac complication

Recurrent stroke

182

21

17

5

264

14.1

1.6

1.3

0.4

20.5

103

17

9

0

123

17.4

2.9

1.5

0

20.7

438

47

32

3

587

16.9

1.8

1.2

0.1

22.6

0.059

0.17

0.86

0.091

0.24

30 days

Mortality rate

264

20.5

123

20.7

587

22.6

0.12

Patient characteristics with time between stroke onset and hospital arrival

Study design : Prospective cohort study

Study duration : 1st July 2009 – 31st Dec 2014

Study tool : Standardized National Stroke registry case

report forms

Variables : time-to-hospital, demographic data, history of

stroke, neurological deficit, functional

outcome and in hospital outcome (length of

stay and 30 day mortality)

RESULT