Emergency Med Medical News about acute stroke care; prehospital; in-hospital delay

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A comprehensive review of prehospital and in-hospital delay times in acute stroke care
International Journal of Stroke, 07/31/09

Evenson KR et al. – The authors identified 123 unique peer–reviewed studies published from 1981 to 2007 of prehospital and in–hospital delay time for evaluation and treatment of patients with stroke, transient ischemic attack, or stroke–like symptoms. Based on studies of 65 different population groups, the weighted Poisson regression indicated a 6·0% annual decline in hours/year for prehospital delay, defined from symptom onset to emergency department arrival. For in–hospital delay, the weighted Poisson regression models indicated no meaningful changes in delay time from emergency department arrival to emergency department evaluation. There was a 10·2% annual decline in hours/year from emergency department arrival to neurology evaluation or notification and a 10·7% annual decline in hours/year for delay time from emergency department arrival to initiation of computed tomography. Only one study reported on times from arrival to computed tomography scan interpretation, two studies on arrival to drug administration, and no studies on arrival to transfer to an in–patient setting, precluding generalizations. Prehospital delay continues to contribute the largest proportion of delay time.

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