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Medical treatment of stroke is dependent on a narrow therapeutic time window.We prospectively analyzed the influence of demo-graphic,medical,and pathophysiologic factors on admission daily 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, lower 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 may reduce daily and save precious time. |
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