뇌졸중 발생 후 급성기 뇌졸중환자들의 초기 반응과 뇌졸중 지식이 병원 도착 전 시간 지연에 주는 영향

Abstract

Backgrounds : Majority of stroke patients are still unable to receive thrombolytic therapy because they do no not reach a hospital within 3 hours from onset. The aims of this study were to know factors including knowledge of stroke which could affect pre-hospital time and the association between first actions of patients after stroke onset and pre-hospital time. Methods : From May 2007 to December 2007, consecutive ischemic stroke patients presented within 3 days from onset and their relatives were interviewed about knowledge of stroke (stroke warning sign, thrombolytic therapy, the three-hour time limit, and use of emergency medical service)and first actions (self-treated, wait and see, seek advice, seek medical advice) at stroke onset. Clinical data of patients were collected from medical records. Results : One hundred fifty three patients were included finally. Thirty seven patients (24.2%) were reached to our hospital within 3 hours from symptom onset. In univariate and multivariate analysis, factors independently associated with presentation within 3 hours were age (odds ratio [OR]0.95, 95% confidence interval [CI] 0.91-0.99, p=0.008), atrial fibrillation (OR 5.02 CI 1.35-18.70, p=0.016), NIHSS at admission (OR 1.09, CI 1.01-1.18, p=0.028), and to know ‘the three-hour time limit’ (OR 3.55, CI 1.45-8.72, p=0.006). In the patients with NIHSS >4 points, to know ‘the three-hour time limit’was only an independent factor associated with presentation within 3 hours. This knowledge was significantly associated with background with completed high school (p=0.038). Patients who sought medical advice were more early arrived to the hospital. The main factors related with seek medical advice were NIHSS (OR 1.13, CI 1.048-1.213, p=0.001) and atrial fibrillation (OR 3.01 CI 1.009-8.948, p=0.048). Conclusions : Knowledge of ‘the three-hour time limit’ was only a modifiable factor which was able to influence on arrival within 3 hours. Initial actions of patients including call emergency medical service affect the pre-hospital time. The public education about stroke knowledge about ‘the three-hour time limit’ and ‘call emergency medical service’ may give a more chance of thrombolysis to acute stroke patients. Key words : Stroke, Thrombolysis, Emergency medical services, Education