Background and purpose: The effectiveness of stroke treatment is highly dependent on the post-onset time of treatment. Recent reports have established the importance of aggressive medical or surgical intervention in the hyperacute stage. In order to design an appropriate treatment program for acute stroke patients, we studied the arrival time after onset of different types of stroke at a tertiary medical center serving the greater Taipei area.
Methods: This was a prospective study of acute stroke patients admitted to the emergency department (ED) during a 1-year period (1997). There were 842 patients with accurate records of hospital arrival time who were either directly or indirectly admitted to the ED during the study period. Each stroke patient had a diagnosis of either cerebral infarction (CI), cerebral hemorrhage (CH), subarachnoid hemorrhage (SAH), or transient ischemic attack (TIA). CI was further divided into five subtypes: large artery atherothrombosis, lacunae, cardioembolism, other specific causes, and undetermined cause. The arrival time after stroke onset was stratified into seven different time intervals: 0 to 3, 3 to 6, 6 to 12, and 12 to 24 hours, and 1 to 3, 3 to 7, and more than 7 days.
Results: Stroke patients who came directly to the ED arrived much sooner after onset than those who came via an indirect route (80.5% vs 36.5% in the first 24 hours). Of the 617 patients in the direct group, the percentage of patients arriving at the ED within 3 hours after onset was significantly greater among CH (66.2%), SAH (68.4%), and TIA (57.9%) patients than among CI (27.4%) patients. The percentage of CI patients who arrived early (0 to 3 hours) was significantly higher in those with cardioembolism (56.3%) than in those with large artery atherothrombosis (24.5%), lacunae (15.3%), other specific causes (13.6%), or undetermined cause (23.2%).
Conclusions: These results show that direct transportation to the ED after stroke onset resulted in shorter treatment delay; hospital arrival time varied significantly among the different types of stroke and subtypes of CI. Patients with hemorrhagic stroke (CH and SAH) and cardioembolism were sent to the ED with the shortest delay. These results may be useful in strategic planning for stroke management.