Maimoona Siddiqui, Shoaib Rasheed Siddiqui, Azra Zafar, Farrukh Shohab Khan.
Factors delaying hospital arrival of patients with acute stroke.
J Pak Med Assoc Jan ;58(4):178-82.

Introduction: To determine the proportion of patients with acute stroke presenting late to hospital and to identify the factors that delay hospital arrival of patients with acute stroke. Methods: A cross sectional study was carried out between Sept 2006 to Feb 2007 in the department of Neurology, Liaquat National Hospital Karachi. All patients of both genders, age >18 years with symptoms of stroke and neuro- imaging (CT scan/ MRI brain) findings consistent with stroke were included. Results: A total of 165 patients attending the Emergency department were included. There were 86 (52%) males and 79 (47.9%) females. The mean age was 60.04±13.98 years, (males 58.2 years and females 61.9 years). The median delay from onset of symptoms to hospital arrival was six hours. Only 28.5% of the patients came within three hours while 71.5% after three hours. Attendants of 47 patients had a low threat perception, 53 (32%) of the patients did not know a single symptom of stroke and 63% (104) patients first contacted their General Practitioner who referred them to hospital. Similarly 60.6% of patients were first taken to a local hospital not equipped to handle major emergencies. Conclusion: Time elapsed from onset of symptoms to hospital arrival is influenced by lack of knowledge of stroke symptoms, contact with a local doctor, low threat perception and non availability of ambulance services (JPMA 58:178;2008).

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