| 증상발생 48시간 이내의 급성 뇌경색과 일과성허혈발작 환자에서 최근 4년간 내원 시간 단축과 관련된 요인 |
| 김석주, 구자성a 이지성b 박지영 박종무 김병건 권오현 이정주 |
| 을지대학교 을지병원 신경과, 가톨릭대학교 의과대학 서울성모병원 신경과a, 고려대학교 의과대학 의학통계학교실b |
| Factors Associated With Reduced Prehospital Delay Over 4 Years in Patients With Acute Ischemic Stroke or Transient Ischemic Attack Within 48 Hours of Symptom Onset |
| Sucjoo Kim |
| Department of Neurology, Eulji General Hospital, Eulji University, Seoul, KoreaDepartment of Neurologya, Seoul St Mary’s Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea Department of Biostatisticsb, Korea University College of Medicine, Seoul, Korea |
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| Abstract |
Background: Prehospital delay is a major obstacle for successful treatment of acute stroke. We investigated the annual change of prehospital delay and related factors in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA).
Methods: From prospective patient registry, demographic and clinical characteristics of patients who presented within 48 hours of symptom onset after AIS or TIA from 2005 to 2008 were analyzed. We compared the annual change of prehospital delay (time from symptom onset to hospital arrival) and the proportion of early arrival (EA-3, prehospital delay<3 h; EA-6, prehospital delay<6 h). We also investigated factors associated with prehospital delay and early arrival.
Results: Of 612 patients, 623 events of AIS or TIA were analyzed. The adjusted geometric mean (95% CI) of prehospital delay (hours) was 7.42 (6.07-9.06) in 2005, 8.18 (6.76-9.89) in 2006, 4.39 (3.50-5.51) in 2007, and 4.02 (3.10-5.22) in 2008 (p<0.01). The proportion of early arrival (year) was 23.6% (2005), 31% (2006), 58% (2007), 54% (2008) for EA-3 (p<0.001) and 38.8% (2005), 32.5% (2006), 51.6% (2007), 75% (2008) for EA-6 (p<0.001). Compared with 2006, the adjusted odds (95% CI) for early arrival were 1.54 (0.87-2.71) in 2005, 1.91 (1.11-3.30) in 2007, 2.29 (1.31-4.01) in 2008 for EA-3 and 1.37 (0.84-2.25) in 2005, 1.73 (1.06-2.81) in 2007, 2.03 (1.23-3.36) in 2008 for EA-6. Younger age, severe neurologic deficit, admission through emergency department, cardioembolic stroke, and TIA were also independently associated with early arrival.
Conclusions: From 2005 to 2008, prehospital delay decreased and potential candidates for thrombolytic therapy increased significantly. KeyWords:Prehospital delay, Ischemic stroke, Transient ischemic attack |
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