Background
Stroke guidelines recommend treatment of acute stroke as a medical emergency. In many countries prolonged delays occur before patients with acute stroke receive medical attention. Only a small percentage of patients are assessed in hospital within the time window for reperfusion therapy. There is limited available published data concerning barriers to acute stroke care in South African patients. The aim of this study was to determine the pre-hospital barriers and in-hospital delays to emergency care for patients presenting to Groote Schuur Hospital (GSH) with acute stroke.
Methods
Eligible patients included were those with a clinical and radiological diagnosis of acute stroke who presented to GSH Emergency Unit and required admission for more than 24 hours. The study was a prospective, observational study with two components: a semi structured interviewer administered questionnaire and a record review of ischaemic stroke patients’ clinical notes within 48 hours of admission to GSH. GSH is a tertiary/academic level hospital in Cape Town, Western Cape province, South Africa. Recruitment took place over a 6-week period.
Results
Demographics: 50 patients were included, with a median age of 61,5 (IQR 44,7 – 70,2) years; gender: females, 29 (58%). Ethnicity: Mixed African ancestry 38 (76%), Black 11 (22%).
Pre- hospital barriers: The median distance to hospital was 12,7 (IQR 10,2 – 17,6) km. Most patients 32 (64%) called for assistance immediately. Frequent reasons cited for delays: waiting for improvement, 7 (38,9%) and failure of symptom recognition 4 (22%). Most patients used their own private transport, 32 (64%) and half of the patients (25) presented directly to GSH. In- hospital delays: The median time interval from arrival at the Emergency Unit to doctor assessment for all the patients was 67,5 (IQR 19,75 – 128,5) minutes. The median door to CT brain time interval for all patients was 5,1 (IQR 1,7 – 10,2) hours and 3,1 (IQR 0,8 – 9,6) hours for those patients that arrived within the thrombolysis time window. Only 21 of 50 patients were referred and assessed by the stroke unit team. Only 3 of the 21 patients received intravenous thrombolysis and none received mechanical thrombectomy.
Conclusion: There majority of the patients who arrived at GSH early after symptom onset used their own private transport and lived close to hospital. Pre-hospital barriers were failure to recognize symptoms, patients hoping for clinical improvement, delays in ambulance transport and routing via secondary hospitals. In hospital delays were prolonged door to doctor assessment and door to CT Brain time intervals.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/30928 |
| Date | 03 February 2020 |
| Creators | Matshikiza, Wonga |
| Contributors | Bryer, Alan |
| Publisher | Faculty of Health Sciences, Department of Medicine |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MMed |
| Format | application/pdf |
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