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KMID : 0385920130240060664
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Journal of the Korean Society of Emergency Medicine
2013 Volume.24 No. 6 p.664 ~ p.673
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Urban-Rural Gap in the Prehospital Delay of Acute Stroke Patients
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Lim Chang-Duk
Ryoo Hyun-Wook
Hwang Yang-Ha
Lee Mi-Jin
Shin Su-Jeong
Ahn Jae-Yun
Kim Jong-Kun
Park Jung-Bae
Seo Kang-Suk
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Abstract
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Purpose: The aim of this study was to compare the difference in acute stroke management between urban and rural areas, to investigate the factors affecting these differences, and to acquire basic information for establishing an efficient regional hub and spoke system for stroke patients.
Methods: This retrospective study was based on adult patients diagnosed with acute ischemic stroke from January 2012 to December 2012 at a regional cerebrovascular center. The term “acute” was defined as 24 hours from symptom recognized. The term “urban” was defined as the region within the boundary of a metropolitan area. The distance from the symptom onset location to the stroke center was calculated using a global positioning system.
Results: The rate of arriving at a stroke center within 3 hours after stroke recognition for acute ischemic stroke patients was much higher in urban areas compared to rural areas (27.5 vs. 19.2%, respectively; p-value=0.011). In stroke cases in rural areas, the distance from symptom onset location to a stroke center was determined as statistically significant through multivariate logistic regression analysis (Odds ratio (OR), 0.982; 95% Confidence interval (CI) 0.969-0.995). In contrast, the use of a public ambulance (OR, 4.258; 95% CI 2.233-8.118) and inter-hospital transfer (OR, 0.416; 95% CI 0.216-0.800) were the main prehospital delay factors in urban areas.
Conclusion: For stroke cases in urban areas, it was important to directly visit a stroke center without transfer using a public ambulance. For rural areas, a new hub hospital and policies are necessary for reducing prehospital delay.
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KEYWORD
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Stroke, Emergency medical service
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