|Journal of Clinical and Applied Neurosciences Volume 2; Issue 1 Jan-Jun 2017|
Pre- and Intra-hospital Delays to Acute Stroke Treatment in a Tertiary Hospital in North-East Nigeria
Olusegun John OLUWOLE, Fatai Kunle SALAWU, Adesola OGUNNIYI
1Neurology Unit, Dept. of Medicine, Federal Teaching Hospital Gombe, NIGERIA
2NeurologyUnit, Dept. of Medicine, Federal Medical Centre Yola, NIGERIA
3NeurologyUnit, Dept. of Medicine, University College Hospital Ibadan, NIGERIA
Olusegun John OLUWOLE
NeuroSpinal Hospital Dubai
United Arab Emirates
Email: email@example.com <mailto:firstname.lastname@example.org>
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The authors have nothing to disclose
Received: 18th May, 2017
Accepted: 29th June, 2017
Background: Recombinant tissue plasminogen activator (rtPA) was approved a decade ago for the treatment of acute ischaemic stroke. The guidelines for its use include stroke onset within 3 hours of intravenous drug administration, preceded by a computed tomographic (CT) scan to exclude the presence of haemorrhage, which is a contraindication to the use of the drug. Thrombolytic therapy in acute ischaemic stroke is currently not in use in Nigeria.
Objective: We sought to study the time, pattern of presentation of acute stroke patients to emergency room and intra-hospital delays in a Nigerian tertiary hospital.
Methodology: A cross-sectional study was carried out between February and November 2015 at the Accident and Emergency room of Federal Medical Centre, Gombe. Eighty-five consecutive patients aged 18years and above with symptoms and/or CT findings consistent with stroke were recruited. Patients who could communicate or their identified care givers were interviewed within 48hours of admission using a structured questionnaire.
Results: Forty-five (52.9%) were males. The mean age was 62.1±13.0. Six patients (7%) presented within 3hours, and the median arrival time for all subjects was 50.9hours. Consultation at another hospital (p=0.00), past history of stroke (p=0.05), and increasing distance from hospital (0.05) were associated with delayed presentation.
Conclusion: Majority (>90%) of acute stroke patients presented after first 3hours. A minority of patients met the time criteria for thrombolytic therapy. There is a need to increase the awareness regarding early recognition, presentation and diagnosis of stroke for timely intervention in Nigeria.
Keywords: Computed tomography, pre-hospital delay, outcome, stroke onset, treatment