FACTORS ASSOCIATED WITH HOSPITAL ARRIVAL TIME IN ISCHEMIC STROKE PATIENTS AT BUDDHASOTHORN HOSPITAL: AN AMBISPECTIVE OBSERVATIONAL COHORT STUDY
DOI:
https://doi.org/10.55374/jseamed.v10.271Keywords:
emergency medical services, hospital arrival time, ischemic stroke, stroke outcomeAbstract
Background: Acute ischemic stroke is a leading cause of death and disability. Timely hospital arrival is critical for effective reperfusion therapy. Objectives: This study aimed to identify factors influencing hospital arrival time and to assess the impact of emergency medical services (EMS) use on clinical outcomes among ischemic stroke patients at Buddhasothorn Hospital.
Methods: We conducted an ambispective observational cohort study of 195 patients with acute ischemic stroke admitted between January 2023 and May 2024, incorporating both retrospective medical record reviews and prospective patient interviews. We analyzed data on baseline characteristics, mode of transport, arrival time, and National Institutes of Health Stroke Scale (NIHSS) scores. Measures of association for delayed arrival (≥4.5 hours) were assessed using multivariate logistic regression to estimate adjusted odds ratios (aORs).
Results: Among 195 patients, 76 (38.9%) arrived within 4.5 hours of symptom onset, and 33 (16.9%) used EMS. Patients arriving within 4.5 hours had significantly lower discharge NIHSS scores compared with those arriving later (3.43 vs. 4.39, p = 0.010). EMS utilization was independently associated with a lower likelihood of delayed hospital arrival (aOR = 0.11, 95% CI: 0.02–0.81, p = 0.030). Additionally, patients with timely arrival demonstrated a greater reduction in mean NIHSS score compared to those with delayed arrival (mean difference in score improvement: 0.96 points, 95% CI: 0.23–1.69).
Conclusion: Early hospital arrival within 4.5 hours is associated with better stroke outcomes, yet the majority of patients still present late. EMS use is independently associated with reduced prehospital delay but remains underutilized.
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