Premium
Referral and care for acute ischemic stroke in a Japanese tertiary emergency hospital
Author(s) -
Yoneda Y.,
Mori E.,
Uehara T.,
Yamada O.,
Tabuchi M.
Publication year - 2001
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1046/j.1468-1331.2001.00275.x
Subject(s) - medicine , thrombolysis , stroke (engine) , referral , emergency medicine , emergency department , acute stroke , tertiary referral hospital , tissue plasminogen activator , tertiary care , pediatrics , retrospective cohort study , myocardial infarction , mechanical engineering , family medicine , psychiatry , engineering
To examine the current emergency referral and care for acute stroke at a Japanese tertiary emergency hospital with a 24‐h stroke team and care unit, we surveyed the presentations of patients with acute ischemic stroke or transient ischemic attack (TIA) seen within 7 days of onset. Delay from symptom onset to arrival at our hospital, from arrival to initial diagnostic brain computed tomography (CT), and the type of anti‐thrombotic treatments were evaluated. During the 18‐month period, there were 254 ischemic events in 244 patients; 239 (94%) had an ischemic stroke and 15 (6%) TIA. Eighty‐two (32%) events presented within 3 h of onset, and 102 (40%) and 179 (70%) within the first 6 and 24 h, respectively. The median delay from hospital arrival to CT was 32 min, ranging 10 min to 22 h. Two hundred (79%) events underwent CT within 1 h of arrival ( n =172) or at the referral hospitals before transfer ( n =28). Direct ambulance transportation and more severe neurological deficits were independent predictors both for early arrival and short in‐hospital delay to CT. Anti‐thrombotic therapies including anticoagulant and/or antiplatelet medications were given in 237 (93%) episodes. Two (1%) patients received thrombolysis, although 18 (7%) patients fulfilled the National Institute of Neurological Disorders and Stroke guidelines for intravenous thrombolysis with tissue plasminogen activator. As in western communities, our pre‐hospital emergency referral systems for acute stroke require substantial improvements including the wider use of ambulance calling. Although our in‐hospital stroke management is functioning relatively well, further efforts are necessary in reducing the diagnostic delay.