Pre- and in-hospital delays in the use of thrombolytic therapy for patients with acute ischemic stroke in rural and urban Egypt
BackgroundReducing pre- and in-hospital delays plays an important role in increasing the rate of intravenous thrombolysis (IVT) in patients with acute ischemic stroke. In Egypt, the IVT rate has increased steadily but is still far away from an ideal rate.AimThe study aimed to investigate the factors...
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Frontiers Media S.A.
2023-01-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.1070523/full |
| _version_ | 1797947017713942528 |
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| author | Ahmed Nasreldein Silke Walter Khaled O. Mohamed Ghaydaa Ahmed Shehata Azza A. Ghali Ahmed Dahshan Klaus Faßbender Foad Abd-Allah |
| author_facet | Ahmed Nasreldein Silke Walter Khaled O. Mohamed Ghaydaa Ahmed Shehata Azza A. Ghali Ahmed Dahshan Klaus Faßbender Foad Abd-Allah |
| author_sort | Ahmed Nasreldein |
| collection | DOAJ |
| description | BackgroundReducing pre- and in-hospital delays plays an important role in increasing the rate of intravenous thrombolysis (IVT) in patients with acute ischemic stroke. In Egypt, the IVT rate has increased steadily but is still far away from an ideal rate.AimThe study aimed to investigate the factors associated with pre- and in-hospital delays of IVT among patients with acute ischemic stroke coming from urban and rural communities.MethodsThis prospective, multicenter, observational cohort study was conducted from January 2018 to January 2019. Patients with acute ischemic stroke, who did not receive IVT, were included in the study. Patients were recruited from three large university stroke centers in Egypt, Assiut (south of Egypt), Tanta (north of Egypt), both serving urban and rural patients, and the University Hospital in Cairo (capital city), only serving an urban community. All participants underwent the National Institutes of Health Stroke Scale and full neurological assessment, urgent laboratory investigations, and computed tomography or magnetic resonance imaging to confirm the stroke diagnosis. The patients were subjected to a structured questionnaire that was designed to determine the parameters and time metrics for the pre- and in-hospital delays among patients from rural and urban regions.ResultsA total of 618 patients were included in the study, of which 364 patients (58.9%) lived in rural regions and 254 (41.1%) in urban regions. General demographic characteristics were similar between both groups. Approximately 73.3% of patients who arrived within the therapeutic time window were urban patients. The time from symptom onset till hospital arrival (onset to door time, ODT) was significantly longer among rural patients (738 ± 690 min) than urban patients (360 ± 342 min). Delayed onset to alarm time (OAT), initial misdiagnosis, and presentation to non-stroke-ready hospitals were the most common causes of pre-hospital delay and were significantly higher in rural patients. For patients arriving within the time window, the most common causes of in-hospital delays were prolonged laboratory investigations and imaging duration.ConclusionThe limited availability of stroke-ready hospitals in rural Egypt leads to delays in stroke management, with subsequent treatment inequality of rural patients with acute stroke. |
| first_indexed | 2024-04-10T21:21:11Z |
| format | Article |
| id | doaj.art-d9a9a46224ca4aa7aa0c081b3f42f6a6 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-10T21:21:11Z |
| publishDate | 2023-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-d9a9a46224ca4aa7aa0c081b3f42f6a62023-01-20T06:12:30ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-01-011310.3389/fneur.2022.10705231070523Pre- and in-hospital delays in the use of thrombolytic therapy for patients with acute ischemic stroke in rural and urban EgyptAhmed Nasreldein0Silke Walter1Khaled O. Mohamed2Ghaydaa Ahmed Shehata3Azza A. Ghali4Ahmed Dahshan5Klaus Faßbender6Foad Abd-Allah7Department of Neurology, Assiut University Hospitals, Assiut University, Asyut, EgyptDepartment of Neurology, Saarland University Hospital, Homburg, GermanyDepartment of Neurology, Assiut University Hospitals, Assiut University, Asyut, EgyptDepartment of Neurology, Assiut University Hospitals, Assiut University, Asyut, EgyptDepartment of Neurology, Faculty of Medicine, Tanta University, Tanta, EgyptDepartment of Neurology, Cairo University Hospitals, Cairo University, Cairo, EgyptDepartment of Neurology, Saarland University Hospital, Homburg, GermanyDepartment of Neurology, Cairo University Hospitals, Cairo University, Cairo, EgyptBackgroundReducing pre- and in-hospital delays plays an important role in increasing the rate of intravenous thrombolysis (IVT) in patients with acute ischemic stroke. In Egypt, the IVT rate has increased steadily but is still far away from an ideal rate.AimThe study aimed to investigate the factors associated with pre- and in-hospital delays of IVT among patients with acute ischemic stroke coming from urban and rural communities.MethodsThis prospective, multicenter, observational cohort study was conducted from January 2018 to January 2019. Patients with acute ischemic stroke, who did not receive IVT, were included in the study. Patients were recruited from three large university stroke centers in Egypt, Assiut (south of Egypt), Tanta (north of Egypt), both serving urban and rural patients, and the University Hospital in Cairo (capital city), only serving an urban community. All participants underwent the National Institutes of Health Stroke Scale and full neurological assessment, urgent laboratory investigations, and computed tomography or magnetic resonance imaging to confirm the stroke diagnosis. The patients were subjected to a structured questionnaire that was designed to determine the parameters and time metrics for the pre- and in-hospital delays among patients from rural and urban regions.ResultsA total of 618 patients were included in the study, of which 364 patients (58.9%) lived in rural regions and 254 (41.1%) in urban regions. General demographic characteristics were similar between both groups. Approximately 73.3% of patients who arrived within the therapeutic time window were urban patients. The time from symptom onset till hospital arrival (onset to door time, ODT) was significantly longer among rural patients (738 ± 690 min) than urban patients (360 ± 342 min). Delayed onset to alarm time (OAT), initial misdiagnosis, and presentation to non-stroke-ready hospitals were the most common causes of pre-hospital delay and were significantly higher in rural patients. For patients arriving within the time window, the most common causes of in-hospital delays were prolonged laboratory investigations and imaging duration.ConclusionThe limited availability of stroke-ready hospitals in rural Egypt leads to delays in stroke management, with subsequent treatment inequality of rural patients with acute stroke.https://www.frontiersin.org/articles/10.3389/fneur.2022.1070523/fullpre-hospitalin-hospitaldelaysthrombolytic therapyurbanrural |
| spellingShingle | Ahmed Nasreldein Silke Walter Khaled O. Mohamed Ghaydaa Ahmed Shehata Azza A. Ghali Ahmed Dahshan Klaus Faßbender Foad Abd-Allah Pre- and in-hospital delays in the use of thrombolytic therapy for patients with acute ischemic stroke in rural and urban Egypt Frontiers in Neurology pre-hospital in-hospital delays thrombolytic therapy urban rural |
| title | Pre- and in-hospital delays in the use of thrombolytic therapy for patients with acute ischemic stroke in rural and urban Egypt |
| title_full | Pre- and in-hospital delays in the use of thrombolytic therapy for patients with acute ischemic stroke in rural and urban Egypt |
| title_fullStr | Pre- and in-hospital delays in the use of thrombolytic therapy for patients with acute ischemic stroke in rural and urban Egypt |
| title_full_unstemmed | Pre- and in-hospital delays in the use of thrombolytic therapy for patients with acute ischemic stroke in rural and urban Egypt |
| title_short | Pre- and in-hospital delays in the use of thrombolytic therapy for patients with acute ischemic stroke in rural and urban Egypt |
| title_sort | pre and in hospital delays in the use of thrombolytic therapy for patients with acute ischemic stroke in rural and urban egypt |
| topic | pre-hospital in-hospital delays thrombolytic therapy urban rural |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.1070523/full |
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