Maintenance of prehospital medical systems due to clinical advance in acute stroke

Introduction

Recently, the medical treatment in acute stroke has been making rapid progress. Especially, in the ischemic stroke of acute stage, the efficacy of thrombolysis, systemic t-PA or local transarterial urokinase infusion has been proved. However, the effective treatment time is still quite limited. The patients must be brought to the stroke center as soon as possible. We analyzed the reason why most stroke patients delay coming to the stroke center. We extracted the problems and proposed some solutions.

Patients and methods

The clinical subjects consisted of 1,112 consecutive patients with ischemic stroke in the acute stage, hospitalized in our hospital between April 2003 and September 2006. We investigated the clinical course, especially the time from the onset to the physical examination, and radiological examinations (CT, MRI, MRA and/or cerebral angiography). The mean age was 72.3 years. Among them, 334 patients were classified as atherothrombosis, 232 were cardiac embolism, 439 were lacunar infarction and 107 were transient ischemic attack. Only 19 patients underwent acute thrombolytic therapy.

Results

Two hundred and forty-one patients (21.7%) were hospitalized within 3 hours from the onset, and 365 patients (32.9%) were within 6 hours. Among them, only 438 were admitted by ambulance. We found the following results. The main reason for the delayed admission is through another hospital, not a stroke center. The patients denied their symptoms are not so rare. The patients or their family often hesitate to request the emergency car.

Conclusion

The most significance point for rapid diagnosis and therapy is that people must doubt 'stroke' at first. We should further educate citizens to the warning signs of stroke and also the necessity of emergency admission using an emergency car. In addition, we should justly build a core stroke center in the district and centralize the patients.