Cargando…

Status of prehospital delay and intravenous thrombolysis in the management of acute ischemic stroke in Nepal

BACKGROUND: Intravenous thrombolysis has been recently introduced in Nepal for the management of acute ischemic stroke. Pre-hospital delay is one of the main reasons that hinder thrombolytic therapy. The objective of this study was to evaluate the status of prehospital delay and thrombolysis in Nepa...

Descripción completa

Detalles Bibliográficos
Autores principales: Nepal, Gaurav, Yadav, Jayant Kumar, Basnet, Babin, Shrestha, Tirtha Man, Kharel, Ghanshyam, Ojha, Rajeev
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6615236/
https://www.ncbi.nlm.nih.gov/pubmed/31288770
http://dx.doi.org/10.1186/s12883-019-1378-3
_version_ 1783433328516399104
author Nepal, Gaurav
Yadav, Jayant Kumar
Basnet, Babin
Shrestha, Tirtha Man
Kharel, Ghanshyam
Ojha, Rajeev
author_facet Nepal, Gaurav
Yadav, Jayant Kumar
Basnet, Babin
Shrestha, Tirtha Man
Kharel, Ghanshyam
Ojha, Rajeev
author_sort Nepal, Gaurav
collection PubMed
description BACKGROUND: Intravenous thrombolysis has been recently introduced in Nepal for the management of acute ischemic stroke. Pre-hospital delay is one of the main reasons that hinder thrombolytic therapy. The objective of this study was to evaluate the status of prehospital delay and thrombolysis in Nepal. METHODS: Data were prospectively collected from patients of both genders, age >  18 years who arrived at the emergency department (ED) with symptoms and neuroimaging findings consistent with an ischemic stroke. Patient data were obtained from ED form and standard questionnaires were used to assess factors resulting in prehospital delay. Modified Rankin scale and National Institute of Health stroke scale were used to assess the degree of disability and severity of stroke respectively. RESULTS: A total of 228 patients were enrolled in the study between August 2017 and August 2018. Only 46 (20.17%) patients arrived within the time frame for thrombolysis. Onset at daytime (OR: 4.07; 95% CI: 1.65–10.1; p = 0.001), stroke symptoms facial deviation (OR: 5.03; 95% CI: 2.47 to 10.26; p = 0.000) and speech disturbances (OR: 2.34; 95% CI: 1.06 to 5.1; p = 0.021), identification of stroke (OR: 22.36; 95% CI: 9.42–53.04;p = 0.000), rushing to ED after onset of symptoms (OR: 2.93; 95% CI: 1.5–5.7; p = 0.001), awareness of treatment of stroke (OR: 10.21; 95% CI: 4.8–21.6; p = 0.000), direct presentation (OR: 4.2; 95% CI: 2.09–8.66; p = 0.000), the distance less than 20 km (OR: 7.9; 95% CI: 3.8–16.5; p = 0.000), and education above high school (OR:4.85; 95% CI: 2.2–10.5; p = 0.000) were associated with early arrival. Heavy traffic, income below 1000 USD per annum and diabetes mellitus were associated with delayed arrival to ED. Out of 46 early arrival patients, only 30 patients (13.15%) received tissue plasminogen activator during the study period, while others were deprived because of their inability to afford the treatment cost. CONCLUSION: Community-based intervention to spread awareness, establishing comprehensive stroke centers, training specialists, improving emergency services, establishment of telestroke facilities and encouraging the use of low-cost tenecteplase as an alternative to alteplase can help improve care for stroke patients in Nepal.
format Online
Article
Text
id pubmed-6615236
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-66152362019-07-18 Status of prehospital delay and intravenous thrombolysis in the management of acute ischemic stroke in Nepal Nepal, Gaurav Yadav, Jayant Kumar Basnet, Babin Shrestha, Tirtha Man Kharel, Ghanshyam Ojha, Rajeev BMC Neurol Research Article BACKGROUND: Intravenous thrombolysis has been recently introduced in Nepal for the management of acute ischemic stroke. Pre-hospital delay is one of the main reasons that hinder thrombolytic therapy. The objective of this study was to evaluate the status of prehospital delay and thrombolysis in Nepal. METHODS: Data were prospectively collected from patients of both genders, age >  18 years who arrived at the emergency department (ED) with symptoms and neuroimaging findings consistent with an ischemic stroke. Patient data were obtained from ED form and standard questionnaires were used to assess factors resulting in prehospital delay. Modified Rankin scale and National Institute of Health stroke scale were used to assess the degree of disability and severity of stroke respectively. RESULTS: A total of 228 patients were enrolled in the study between August 2017 and August 2018. Only 46 (20.17%) patients arrived within the time frame for thrombolysis. Onset at daytime (OR: 4.07; 95% CI: 1.65–10.1; p = 0.001), stroke symptoms facial deviation (OR: 5.03; 95% CI: 2.47 to 10.26; p = 0.000) and speech disturbances (OR: 2.34; 95% CI: 1.06 to 5.1; p = 0.021), identification of stroke (OR: 22.36; 95% CI: 9.42–53.04;p = 0.000), rushing to ED after onset of symptoms (OR: 2.93; 95% CI: 1.5–5.7; p = 0.001), awareness of treatment of stroke (OR: 10.21; 95% CI: 4.8–21.6; p = 0.000), direct presentation (OR: 4.2; 95% CI: 2.09–8.66; p = 0.000), the distance less than 20 km (OR: 7.9; 95% CI: 3.8–16.5; p = 0.000), and education above high school (OR:4.85; 95% CI: 2.2–10.5; p = 0.000) were associated with early arrival. Heavy traffic, income below 1000 USD per annum and diabetes mellitus were associated with delayed arrival to ED. Out of 46 early arrival patients, only 30 patients (13.15%) received tissue plasminogen activator during the study period, while others were deprived because of their inability to afford the treatment cost. CONCLUSION: Community-based intervention to spread awareness, establishing comprehensive stroke centers, training specialists, improving emergency services, establishment of telestroke facilities and encouraging the use of low-cost tenecteplase as an alternative to alteplase can help improve care for stroke patients in Nepal. BioMed Central 2019-07-09 /pmc/articles/PMC6615236/ /pubmed/31288770 http://dx.doi.org/10.1186/s12883-019-1378-3 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Nepal, Gaurav
Yadav, Jayant Kumar
Basnet, Babin
Shrestha, Tirtha Man
Kharel, Ghanshyam
Ojha, Rajeev
Status of prehospital delay and intravenous thrombolysis in the management of acute ischemic stroke in Nepal
title Status of prehospital delay and intravenous thrombolysis in the management of acute ischemic stroke in Nepal
title_full Status of prehospital delay and intravenous thrombolysis in the management of acute ischemic stroke in Nepal
title_fullStr Status of prehospital delay and intravenous thrombolysis in the management of acute ischemic stroke in Nepal
title_full_unstemmed Status of prehospital delay and intravenous thrombolysis in the management of acute ischemic stroke in Nepal
title_short Status of prehospital delay and intravenous thrombolysis in the management of acute ischemic stroke in Nepal
title_sort status of prehospital delay and intravenous thrombolysis in the management of acute ischemic stroke in nepal
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6615236/
https://www.ncbi.nlm.nih.gov/pubmed/31288770
http://dx.doi.org/10.1186/s12883-019-1378-3
work_keys_str_mv AT nepalgaurav statusofprehospitaldelayandintravenousthrombolysisinthemanagementofacuteischemicstrokeinnepal
AT yadavjayantkumar statusofprehospitaldelayandintravenousthrombolysisinthemanagementofacuteischemicstrokeinnepal
AT basnetbabin statusofprehospitaldelayandintravenousthrombolysisinthemanagementofacuteischemicstrokeinnepal
AT shresthatirthaman statusofprehospitaldelayandintravenousthrombolysisinthemanagementofacuteischemicstrokeinnepal
AT kharelghanshyam statusofprehospitaldelayandintravenousthrombolysisinthemanagementofacuteischemicstrokeinnepal
AT ojharajeev statusofprehospitaldelayandintravenousthrombolysisinthemanagementofacuteischemicstrokeinnepal