Emergency care for stroke victims: it all depends on how you arrive and where you go

My husband and I watched “The Namesake” the other day and I remember that scene where the father Ashoke presented himself at the ER and had to stand in line for a long time, leading to his death due to a heart attack. Unfortunately, this scenario does not only happen in movies but in real life as well. In a  CVD news item last week, I cited that the average waiting time in an ER is almost an hour – 60 minutes which can make the difference between recovery and disability, between life and death.

This study reported in the journal Stroke looked at 15,117 stroke victims from 46 hospitals listed in the North Carolina Stroke Registry (January 2005 to April 2008) and the findings are as follows:

Only 23 percent arrived at the hospital within two hours of symptom onset and were suitable for evaluation to receive tPA [tissue plasminogen activator].

Those who arrived by ambulance were more than twice as likely to receive timely CT scans as those who “walked in” on their own.

It seems that many factors can influence how timely a patient gets proper care.

Time of arrival and mode of transport

Arrival at a hospital soon after the onset of symptoms is very important, for obvious reasons that the sooner medical help is given, the better. However, there are also very specific reasons having to do with time-dependent medications and diagnostics tools.

The drug tPA helps prevent clots, thereby reducing the likelihood of disability from ischemic stroke. However, it is only supposed to be used within 3 hours after the onset of the symptoms. Ischemic stroke is reported to be the most common type of stroke diagnosed at admission (43%).

Upon a patient’s arrival at the ER, it is recommended by the Current National Institute of Neurological Disorders and Stroke (NINDS) that a computer tomography (CT) scan be performed within 25 minutes. However, this doesn’t seem to be case, with a mere 23.6% getting a CT scan according to the said guidelines.

The manner of arrival seems to matter. Those who simply “walk in” and present themselves are less likely to get the care their urgently need than those who arrived by ambulance. Understandably, the latter mode of arrival seems to send a message of urgency to ER staff so that “arriving at a hospital by ambulance … lead to faster stroke diagnosis and speed treatment.”

Type of hospital

Specialized centers such as Primary Stroke Centers provide timely care and perform CT scans faster than other less specialized hospitals.

Gender and other factors

For unknown reasons, men tend to get CT scan performed faster than women. However, ethnicity, health insurance, and time of the day do not seem to make much of a difference.

The results of the study show that time is of utmost importance in the treatment of stroke victims. For this reason, it is vital that we

• recognized the symptoms (see warning signs, American Stroke Association)
• call for emergency help (call 9-1-1)