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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
