Status of prehospital delay and intravenous thrombolysis in the management of acute ischemic stroke in Nepal.
BMC Neurology · 2019-07-09 · Observational study
Abstract
BACKGROUND: Intravenous thrombolysis has been recently introduced in Nepal for the management of acute ischemic stroke. Pre-hospital delay is one of the main reasons that hinder thrombolytic therapy. The objective of this study was to evaluate the status of prehospital delay and thrombolysis in Nepal. METHODS: Data were prospectively collected from patients of both genders, age > 18 years who arrived at the emergency department (ED) with symptoms and neuroimaging findings consistent with an ischemic stroke. Patient data were obtained from ED form and standard questionnaires were used to assess factors resulting in prehospital delay. Modified Rankin scale and National Institute of Health stroke scale were used to assess the degree of disability and severity of stroke respectively. RESULTS: A total of 228 patients were enrolled in the study between August 2017 and August 2018. Only 46 (20.17%) patients arrived within the time frame for thrombolysis. Onset at daytime (OR: 4.07; 95% CI: 1.65-10.1; p = 0.001), stroke symptoms facial deviation (OR: 5.03; 95% CI: 2.47 to 10.26; p = 0.000) and speech disturbances (OR: 2.34; 95% CI: 1.06 to 5.1; p = 0.021), identification of stroke (OR: 22.36; 95% CI: 9.42-53.04;p = 0.000), rushing to ED after onset of symptoms (OR: 2.93; 95% CI: 1.5-5.7; p = 0.001), awareness of treatment of stroke (OR: 10.21; 95% CI: 4.8-21.6; p = 0.000), direct presentation (OR: 4.2; 95% CI: 2.09-8.66; p = 0.000), the distance less than 20 km (OR: 7.9; 95% CI: 3.8-16.5; p = 0.000), and education above high school (OR:4.85; 95% CI: 2.2-10.5; p = 0.000) were associated with early arrival. Heavy traffic, income below 1000 USD per annum and diabetes mellitus were associated with delayed arrival to ED. Out of 46 early arrival patients, only 30 patients (13.15%) received tissue plasminogen activator during the study period, while others were deprived because of their inability to afford the treatment cost. CONCLUSION: Community-based intervention to spread awareness, establishing comprehensive stroke centers, training specialists, improving emergency services, establishment of telestroke facilities and encouraging the use of low-cost tenecteplase as an alternative to alteplase can help improve care for stroke patients in Nepal.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Antithrombotics & thrombolytics · Equity & disparities · Low- and middle-income settings · Thrombolytics · Time intervals
Related articles
- A systematic review of barriers to delivery of thrombolysis for acute stroke. (Age Ageing, 2004)
- Urban-rural inequalities in IV thrombolysis for acute ischemic stroke: A nationwide study. (Eur Stroke J, 2024)
- Disparities in Reperfusion Therapy and Time Delays Among Patients With Ischemic Stroke and a History of Mental Illness. (Stroke, 2022)
- Barriers to Thrombolysis at A Tertiary Care Public Hospital- A Prospective Observational Study from Southern Part of India. (Neurol India, 2022)
- Pre- and in-hospital delays in the use of thrombolytic therapy for patients with acute ischemic stroke in rural and urban Egypt. (Front Neurol, 2022)
- Late Hospital Arrival for Thrombolysis after Stroke in Southern Portugal: Who Is at Risk? (J Stroke Cerebrovasc Dis, 2019)