Conflict of interest: None.
A comprehensive review of prehospital and in-hospital delay times in acute stroke care
Article first published online: 20 JUL 2009
© 2009 The Authors. © 2009 World Stroke Organization
International Journal of Stroke
Volume 4, Issue 3, pages 187–199, June 2009
How to Cite
Evenson, K. R., Foraker, R. E., Morris, D. L. and Rosamond, W. D. (2009), A comprehensive review of prehospital and in-hospital delay times in acute stroke care. International Journal of Stroke, 4: 187–199. doi: 10.1111/j.1747-4949.2009.00276.x
Funding: Randi E. Foraker was funded by the National Institutes of Health (NIH), NHLBI NRSA Training Grant No. 5-T32-HL007055-30.
- Issue published online: 20 JUL 2009
- Article first published online: 20 JUL 2009
- acute stroke therapy;
- CT scan;
The purpose of this study was to systematically review and summarize prehospital and in-hospital stroke evaluation and treatment delay times. We 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 (P<0·001) 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 (3·1%, P=0·49 based on 12 population groups). There was a 10·2% annual decline in hours/year from emergency department arrival to neurology evaluation or notification (P=0·23 based on 16 population groups) and a 10·7% annual decline in hours/year for delay time from emergency department arrival to initiation of computed tomography (P=0·11 based on 23 population groups). 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. The next decade provides opportunities to establish more effective community-based interventions worldwide. It will be crucial to have effective stroke surveillance systems in place to better understand and improve both prehospital and in-hospital delays for acute stroke care.