Factors associated with delays in receipt of emergency treatment for acute stroke patients in Lebanon

Abstract

The aim of the study was to explore the characteristics of patients admitted through the Emergency Department (ED) with acute stroke to a private hospital in Lebanon and factors associated with the delay in their seeking emergency treatment.

Stroke is the leading cause of long-term disabilities worldwide. Stroke in Lebanon is considered as the third cause of premature deaths. Ischemic stroke (IS) is the most common type of strokes with an 85% prevalence versus 15% for hemorrhagic strokes. Mortality and morbidity in stroke were found to be associated with delays in receiving effective treatments such as thrombolytic therapy for ischemic stroke. Studies have shown a substantial proportion of patients failing to receive such therapies because they do not reach the emergency department (ED) within the 4.5hour therapeutic window. In Lebanon, there are no studies to our knowledge that addressed the issue of delay in receipt of treatment in patients with acute stroke.

A retrospective descriptive design was used. Data collection was through a medical record review of all consecutive acute ischemic stroke patients admitted to the ED of the American University of Beirut Medical Center (AUBMC) between January 1st, 2016, and January 1st, 2019. Inclusion criteria included age 18 years and older, diagnosis of stroke, and admission to the hospital. Patients with transient ischemic attacks were excluded. Data included demographic characteristics, medical history, date and time of symptom onset, date and time of arrival to ED, symptoms and ED transport and management.

There was a total of 205 patients who met the study criteria. The median delay time was 4.57 hours, with 49.7% reaching the ED within 4.5 hours of symptom onset. Living outside Beirut, history of prior stroke or having dysphagia predicted longer delays, whereas losing consciousness and coming to the ED by ambulance predicted shorter delays

The study findings highlight the importance of educational campaigns about symptoms of stroke and the importance of prompt seeking emergency care for the treatment to be effective.