The Relationship between Functional Outcome and Prehospital Time Interval in Patients with Cerebral Infarction

J Stroke Cerebrovasc Dis. 2017 Dec;26(12):2800-2805. doi: 10.1016/j.jstrokecerebrovasdis.2017.06.059. Epub 2017 Jul 31.

Abstract

Background: When symptoms of cerebral infarction are recognized in a patient, he or she should be transported to a hospital and should be started on the appropriate treatments. The effectiveness of delayed treatment of cerebral infarction with respect to the initial diagnosis or perception of the disease is still unclear.

Methods: We retrospectively investigated whether the functional outcomes would improve if patients with cerebral infarction were transported to the hospital with minimum delay. One-hundred twenty-two patients who were transported to Mishuku Hospital from January 2012 to August 2015 were included. We conducted multiple regression analyses. The criterion variable included the BI at discharge, and the explanatory variables were age, sex, days of hospital stay, the Barthel Index (BI) on admission, time from symptom onset to hospital arrival, time from emergency medical service perception to hospital arrival, recombinant tissue plasminogen activator (rt-PA) treatment, and the occluded artery type.

Results: In all 122 cases, the BI at the time of discharge was not related to onset time (P = .453) but was significantly related to perception time (P = .026). BI scores at discharge were high for young patients (P = .002) and for patients with short hospital stays (P <.001). In the rt-PA group (52 cases), BI scores at discharge were also high when the perception time was short (P = .036).

Conclusions: A short interval between perception and hospital arrival improves the functional outcomes for patients with cerebral infarction. Thus, patients with cerebral infarctions must be treated with minimal delay after diagnosis of the condition.

Keywords: Barthel Index; Transportation time; cerebral infarction; functional outcome; onset time; perception time; rt-PA.

MeSH terms

  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Cerebral Infarction / diagnosis
  • Cerebral Infarction / physiopathology
  • Cerebral Infarction / therapy*
  • Disability Evaluation
  • Early Diagnosis
  • Emergency Medical Services*
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / adverse effects
  • Health Status
  • Humans
  • Japan
  • Length of Stay
  • Male
  • Middle Aged
  • Patient Care Team
  • Patient Discharge
  • Predictive Value of Tests
  • Recovery of Function
  • Retrospective Studies
  • Risk Factors
  • Thrombolytic Therapy / adverse effects
  • Thrombolytic Therapy / methods*
  • Time Factors
  • Time-to-Treatment*
  • Tissue Plasminogen Activator / administration & dosage*
  • Tissue Plasminogen Activator / adverse effects
  • Transportation of Patients
  • Treatment Outcome

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator