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ARTICLES
August 1, 1996

Factors delaying hospital admission in acute stroke
The Copenhagen Stroke Study

August 1996 issue
47 (2) 383-387

Abstract

Medical treatment of stroke is dependent on a narrow therapeutic time window.We prospectively analyzed the influence of demographic, medical, and pathophysiologic factors on admission delay in 1,197 unselected, acute stroke patients. Twenty five percent were admitted within 3 1/2 hours, 35% within 6 hours, 50% within 14 hours, and 68% within 24 hours after stroke onset. Living alone (odds ratio [OR] 1.75, 95% CI 1.3 to 2.3) and retired working status (OR 1.61, 95% CI 1.01 to 2.54) delayed admission. A well-working social network thus seems important to early admission. The milder the stroke, the higher was the risk of delayed admission (OR 1.25 per 10 points decrease in stroke severity [Scandinavian Neurological Stroke Scale score on admission], 95% CI 1.14 to 1.36). A history of TIA increased the relative chance of early admission by odds 1.64 (95% CI 1.06 to 2.54). Other factors such as age, sex, diabetes, hypertension, ischemic heart disease, other comorbidity, previous stroke, headache, aphasia, apraxia, anosognosia, neglect, lowered consciousness, mental status (Mini-Mental State Examination) and type of stroke (hemorrhage/infarct) had no independent influence on admission time. Admission was markedly delayed in most patients. This represents a major barrier to medical treatment. Patients with the most severe strokes are admitted early, but patients with milder symptoms should also be encouraged to seek immediate admission. The observation that a history of TIA reduced admission time indicates that an increase in public awareness and knowledge may reduce delay and save precious time.
NEUROLOGY 1996;47: 383-387

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REFERENCES

1.
Bath PM. Treating acute ischemic stroke. BMJ 1995;311:139-140.
2.
Wise RJS, Bernardi S, Frackowiak RSJ, Legg NJ, Jones T. Serial observations on the pathophysiology of acute stroke. Brain 1983;106:197-222.
3.
Alberts MJ, Bertels C, Dawson DV. An analysis of time of presentation after stroke. JAMA 1990;263:65-68.
4.
Harper GD, Haigh RA, Potter JF, Castleden CM. Factors delaying hospital admission after stroke in Leicestershire. Stroke 1992;23:835-838.
5.
Barsan WG, Brott TG, Broderick JP, Haley EC, Levy DE, Marler JR. Time of hospital presentation in patients with acute stroke. Arch Intern Med 1993;153:2558-2561.
6.
Anderson NE, Broad JB, Bonita R. Delays in hospital admission and investigation in acute stroke. BMJ 1995;311:162.
7.
Jorgensen HS, Plesner AM, Hubbe P, Larsen K. Marked increase of stroke incidence in men between 1972 and 1990 in Frederiksberg, Denmark. Stroke 1992;23:1701-1704.
8.
Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Stroke in patients with diabetes. The Copenhagen Stroke Study. Stroke 1994;25:1977-1984.
9.
Scandinavian Stroke Study Group. Multicenter trial of hemodilution in ischemic stroke: background and study protocol. Stroke 1985;16:885-890.
10.
Lindenstrom E, Boysen G, Christiansen LW, a Rogvi-Hansen B, Nielsen BW. Reliability of Scandinavian Stroke Scale. Cerebrovasc Dis 1991;1:103-107.
11.
Folstein MF, Folstein SE, McHugh PR. Mini Mental State: a practical method for grading the cognitive status of patients for the clinicians. J Psychiatr Res 1975;12:189-198.
12.
Mahoney FD, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J 1965;14:61-63.
13.
Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Intracerebral hemorrhage versus infarction: stroke severity, risk factors, and prognosis. Ann Neurol 1995;38:45-50.
14.
Alberts MJ, Perry A, Dawson D. Effects of public and professional education on reducing the delay in presentation and referral of stroke patients. Stroke 1992;23:352-356.
15.
Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Effect of blood pressure and diabetes on stroke in progression. Lancet 1994;344:156-159.

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Published In

Neurology®
Volume 47Number 2August 1996
Pages: 383-387
PubMed: 8757008

Publication History

Published online: August 1, 1996
Published in print: August 1996

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Authors

Affiliations & Disclosures

From the departments of Neurology (Drs. Jorgensen, Nakayama, Reith, and Olsen) and Radiology (Dr. Raaschou), Bispebjerg Hospital, Copenhagen, Denmark.
Supported by grants from The Danish Health Foundation, The Danish Heart Foundation, Ebba Celinders Foundation, and The Gangsted Foundation.
Received November 30, 1995. Accepted in final form January 26, 1996.
Address correspondence and reprint requests to Dr. Henrik Stig Jorgensen, Department of Neurology, Bispebjerg Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark.

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