FACTORS CAUSING DELAY IN TIME TO DOOR AT EMERGENCY DEPARTMENT(ED) IN CASES OF ACUTE STROKE AND IT'S IMPACT ON OUTCOME AT TERTIARY CARE CENTRE-Reference-Cited by-同舟云学术

FACTORS CAUSING DELAY IN TIME TO DOOR AT EMERGENCY DEPARTMENT(ED) IN CASES OF ACUTE STROKE AND IT'S IMPACT ON OUTCOME AT TERTIARY CARE CENTRE

Published:2020-05-01 Issue: Volume: Page:67-70
ISSN:
Container-title:INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH
language:en
Short-container-title:ijsr

Author:

Yadav Yogender Kumar¹,Shah Dina J²,Sharma Jyoti B³,Pandey Nalini Bala⁴

Affiliation:

1. MBBS, DNB (Emergency Medicine), Senior Registrar, Emergency Medicine Department, Manipal Hospital, Dwarka, New Delhi.

2. MBBS, MD (Anaesthesiology), P.G.Dip. And Masters Emergency Medicine(Aus.) Director And Head Of The Department, Department Of Emergency Medicine Fortis Hospital Noida. Uttar Pradesh, India.

3. MBBS, MD (Medicine) DM (Neurology) Director And Head Of The Department, Department Of Neurology, Fortis Hospital Noida, Uttar Pradesh, India.

4. MBBS, DGO, DNB (Emergency Medicine),Consultant Emergency Medicine, Department Of Obstetrics And Gynaecology, Lok Nayak Hospital, New Delhi.

Abstract

BACKGROUND: The effectiveness of stroke management is highly dependent on post onset time of treatment. The study hypothesized that perceptual, social and behavioral factors affect delay in seeking help after symptom onset and worsen the outcome and recovery. OBJECTIVE: To look at the causes of delay in arrival to denitive care hospital ED after symptoms of acute stoke and its impact on patient's clinical outcome. METHODS: An observational prospective study conducted on 63 patients with signs and symptoms of acute stroke (CPSS/NIHSS positive) reported to ED. Reasons for delay in arrival to ED observed. Patients divided into two groups, those who came within 4.5 hours of onset of acute stroke symptoms and those who came after 4.5 hours. Impact of delay on patient's outcome studied at time of discharge as primary end-points in terms of average length of stay (ALOS), complications and death. Secondary end-points evaluate in terms of improvement, deterioration and death within 30th day. Statistical analysis using Chi-square or Fisher's exact test applied to compare both the groups. Odds ratio with 95 % condence limit was also calculated. RESULTS: There were multiple overlapping causes of delay; most frequently was “rst went to physician who doesn't treat stroke (8; 38.1%) and non-availability of nearby stroke centre (8; 38.1%)”. Total 21 (33.34%) patients came after window period (4.5hours). Primary endpoints in terms of ALOS (8 days compared to 9 days, p=0.48), complications (OR=1.4, 95%CI:0.2-8.8, p=0.74) and death (OR=3, 95%CI:0.4-19.3, p=0.24) at time of discharge. Secondary endpoints in terms of improvement (OR=2.8, 95%CI:1.0-7.8, p=0.03), deterioration (OR=6.0, 95%CI:1.4-24.5, p=0.01) and death within 30 days (OR=1.2, 95%CI:0.2-5.5, p=0.81). CONCLUSION: Inadequate knowledge of stroke identication and management causes delay in arrival to hospital. This delay can cause signicant impact on patient outcome and recovery

Publisher

World Wide Journals

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