Objective: Thrombolysis is a time-dependent therapy. It is therefore very important how fast stroke patients can reach hospital. The present study was designed to assess which proportion of patients with stroke (from the population of Szczecin, the capital of West Pomerania Province, Poland) reaches hospital within the recommended time from the thrombolytic therapy point of view. The purpose of our study was also to elucidate which factors can influence the time before the ambulance service is called. Patients and Methods: The study involved 1,015 patients with stroke admitted to the Emergency Department of the University Hospital, Szczecin. Results: 235 patients (23.1%) were admitted to the hospital within the appropriate period for thrombolytic therapy. Hospital arrival time was significantly earlier in older patients and in patients with severer neurological deficits. We also observed a tendency for faster hospitalization of women, the highly educated, and patients regularly using antiplatelet drugs for cardiovascular disease prevention. Conclusions: The percentage of stroke patients hospitalized within 2 h after stroke onset should be increased. The most susceptible subpopulations in our country seem to be older patients, the highly educated and patients regularly using antiplatelet drugs for cardiovascular disease prevention.

Keywords:
Stroke onset, Prehospital delay, Therapeutic window, Thrombolysis
1.
Mancia G: Prevention and treatment of stroke in patients with hypertension. Clin Ther 2004;26:631–648.
2.
Brainin M, Bornstein N, Boysen G, Demarin V, for the EFNS Task Force on Acute Neurological Stroke Care in Europe: Acute neurological stroke care in Europe: results of the European Stroke Care Inventory. Eur J Neurol 2000;7:5–10.
3.
Pendlebury ST, Rothwell PM, Algra A, Ariesen MJ, Bakac G, Czlonkowska A, Dachenhausen A, Krespi Y, Korv J, Krolikowski K, Kulesh S, Michel P, Thomassen L, Bogousslavsky J, Brainin M: Underfunding of stroke research. A Europe-wide problem. Stroke 2004;35:2368–2371.
4.
World Health Organization: The World Health Report: Shaping the Future. Geneva, WHO, 2003, pp 1–20, 83–99.
5.
Bravata DM, Ho SY, Brass LM, Concato J, Scinto J, Meehan TP: Long-term mortality in cerebrovascular disease. Stroke 2003;34:699–704.
6.
Kaarisalo MM, Raiha H, Sivenius J, Immonen-Raiha P, Lehtonen A, Sarti C, Mahonen M, Torppa J, Tuomilehto J, Salomaa V: Diabetes worsens the outcome of acute ischemic stroke. Diabetes Res Clin Pract 2005;69:293–298.
7.
Musolino R, La Spina P, Serra S, Postorino P, Calabro S, Savica R, Salemi G, Gallitto G: First-ever stroke incidence and 30-day case fatality in the Sicilian Aeolian archipelago, Italy. Stroke 2005;36:2738–2741.
8.
Hankey GJ: Long-term outcome after ischemic stroke/transient ischemic attack. Cerebrovasc Dis 2003;16:14–19.
9.
Ryglewicz D, Hier DB, Wiszniewska M, Cichy S, Lechowicz W, Członkowska A: Ischemic strokes are more severe in Poland than in the United States. Neurology 2000;54:513–515.
10.
Weir NU, Sandercock PA, Lewis SC, Signorini DF, Warlow CP: Variations between countries in outcome after stroke in the International Stroke Trial (IST). Stroke 2001;32:1370–1377.
11.
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group: Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–1588.
12.
Kaste M: Approval of alteplase in Europe: will it change stroke management? Lancet Neurol 2003;2:207–208.
13.
Whiteley W, Lindley R, Wardlaw J, Sandercock P, on behalf of the IST-3 Collaborative Group: Third International Stroke Trial. Int J Stroke 2006;1:172–176.
14.
Butcher KS, Parsons M, MacGregor L, Barber PA, Chalk J, Bladin C, Levi C, Kimber T, Schultz D, Fink J, Tress B, Donnan G, Davis S, for the EPITHET Investigators: Refining the perfusion–diffusion mismatch hypothesis. Stroke 2005;36:1153–1159.
15.
Pandian JD, Kalra G, Jaison A, Deepak SS, Shamsher S, Singh Y, Abraham G: Knowledge of stroke among stroke patients and their relatives in Northwest India. Neurol India 2006;54:152–156.
16.
De Dominicis L, Cardinali P, Pucci E, Marchegiani G, Caporalini R, Moretti V, Sanguigni S, Carle F, Gesuita R, Giuliani G: What do Italians at high risk of stroke know about ischaemic stroke? A survey among a group of subjects undergoing neuro-sonographic examination. Neurol Sci 2006;27:7–13.
17.
Centers for Disease Control and Prevention (CDC): Awareness of stroke warning signs – 17 states and the US Virgin Islands, 2001. MMWR Morb Mortal Wkly Rep 2004;53:359–362.
18.
Albers GW, Amarenco P, Easton JD, Sacco RL, Teal P: Antithrombotic and thrombolytic therapy for ischemic stroke: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest2004;126:483S–512S.
19.
Chang KC, Tseng MC, Tan TY: Prehospital delay after acute stroke in Kaohsiung, Taiwan. Stroke 2004;35:700–704.
20.
Silvestrelli G, Parnetti L, Paciaroni M, Caso V, Corea F, Vitali R, Capocchi G, Agnelli G: Early admission to stroke unit influences clinical outcome. Eur J Neurol 2006;13:250–255.
21.
Harraf F, Sharma AK, Brown MM, Lees KR, Vass RI, Kalra L: A multicentre observational study of presentation and early assessment of acute stroke. BMJ 2002;325:17.
22.
Morris DL, Rosamond W, Madden K, Schultz C, Hamilton S: Prehospital and emergency department delays after acute stroke: the Genentech Stroke Presentation Survey. Stroke2000;31:2585–2590.
23.
Lacy C, Suh D, Bueno M, Kostis J, for the STROKE Collaborative Study Group: Delay in presentation and evaluation for acute stroke: Stroke Time Registry for Outcomes Knowledge and Epidemiology (STROKE). Stroke2001;32:63–69.
24.
Derex L, Adeleine P, Nighoghossian N, Honnorat J, Trouillas P: Factors influencing early admission in a French stroke unit. Stroke2002;33:153–159.
25.
Bohannon RW, Silverman IE, Ahlquist M: Time to emergency department arrival and its determinants in patients with acute ischemic stroke. Conn Med 2003;67:145–148.
26.
Iguchi Y, Wada K, Shibazaki K, Inoue T, Ueno Y, Yamashita S, Kimura K: First impression at stroke onset plays an important role in early hospital arrival. Intern Med 2006;45:447–451.
27.
Nedeltchev K, Arnold M, Brekenfeld C, Isenegger J, Remonda L, Schroth G, Mattle HP: Pre- and in-hospital delays from stroke onset to intra-arterial thrombolysis. Stroke 2003;34:1230.
28.
Kothari R, Sauerbeck L, Jauch E, Broderick J, Brott T, Khoury J, Liu T: Patients’ awareness of stroke signs, symptoms, and risk factors. Stroke1997;28:1871–1875.
29.
Williams JE, Rosamond WD, Morris DL: Stroke symptom attribution and time to emergency department arrival: the delay in accessing stroke healthcare study. Acad Emerg Med 2000;7:93–96.
30.
Morgenstern LB, Staub L, Chan W, Wein TH, Bartholomew LK, King M, Felberg RA, Burgin WS, Groff J, Hickenbottom SL, Saldin K, Demchuk AM, Kalra A, Dhingra A, Grotta JC: Improving delivery of acute stroke therapy: the TLL Temple Foundation Stroke Project. Stroke2002;33:160–166.
31.
Kwan J, Hand P, Sandercock P: Improving the efficiency of delivery of thrombolysis for acute stroke: a systematic review. QJM 2004;97:273–279.
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2007
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