Symptom-to-needle Times in Acute Ischemic Stroke and Its Prehospital Related Factors

Intravenous (IV) recombinant tissue Plasminogen Activator (rtPA) (IV-rtPA) is the only FDA-approved pharmacological therapy for treatment in acute ischemic stroke and the administration of IV-rtPA is crucially time-dependent.

This study aimed to evaluate symptom-to-needle time and factors associated with the prehospital delay in patients with acute ischemic stroke referred to Poursina Hospital, a referral hospital in the north of Iran.

In this cross-sectional study, all patients with acute stroke referred to Poursina Hospital from June to December 2016 were evaluated. The study data were extracted from the patients’ records. SPSS v. 21 was used to analyze the obtained data. The independent samples t-test and the Chi-square test were used to explore the appropriate relation of variables.

A total of 322 patients were included. Their mean age was 74.4 years and 55.6% were male. According to findings, only 74 patients (22.98%) were transferred to the hospital via Emergency Medical Service (EMS), most of them (64.86%) arrived at the right time. There is a significant relationship between EMS transfer use and arriving at the hospital at the right time. Overall, 13.9% of patients received IV rtPA, and 75.5% of the patients received rtPA in less than 60 minutes. Among the patients arrived in the golden time, the average times to treatment were as follows: onset-to-door (OTD), 105 min; door-to-admission, 3 min; admission-to-doctor, 7 min; doctor-to-Computed Tomography (CT), 15 min; CT-to-treatment, 26 min; symptom to needle time, 152 min; and door-to-needle time (DNT), 49 min.

According to this study, although the two-third of eligible patients were transferred to the hospital at the right time, the rate of using EMS for patient transportation is low.