ArticlePloS one2021
Impact of onset-to-door time on outcomes and factors associated with late hospital arrival in patients with acute ischemic stroke.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers.
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Who cites it
33 citing papers in PubMed.
- Behavioral Determinants Potentially Relevant to First-Witness Responses in Prehospital Stroke Care: A COM-B-Based Scoping Review.Healthcare (Basel, Switzerland) · 2026Review
- Diagnostic accuracy of the ROSIER scale for detecting acute ischemic stroke: a comparison with FAST-ED, CPSS, and reference criteria.BMC emergency medicine · 2026Article
- Relationship between stroke onset timing and clinical outcomes in ischemic and hemorrhagic strokes: a systematic review.International journal of cardiology. Cardiovascular risk and prevention · 2026Review
- Development of a Risk Prediction Model for Post-Stroke Functional Recovery Based on Clinical and Nursing Factors.Risk management and healthcare policy · 2026Article
- Precipitation, EMS use, and time to presentation of Acute Ischemic stroke in the get with the guidelines-stroke registry.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2025Article
- Analysis of prehospital delay in acute ischaemic stroke and its influencing factors: a multicentre prospective case registry study in China.Stroke and vascular neurology · 2025Article
- Real-time in vivo imaging of rodent brain response to hypoperfusion enabled by remotely controlled elastomeric micro-balloons.bioRxiv : the preprint server for biology · 2025Article
- Procedure Time of Endovascular Thrombectomy as Performance Measure of Acute Stroke Treatment.Neurointervention · 2025Article
- Tenecteplase Beyond 4.5 Hours in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.Journal of stroke · 2025Review
- Late neurological improvement during hospitalization is a predicative factor for acute ischemic stroke.European journal of medical research · 2025Article
- Clinical profile of adult stroke patients in Angola: a cross-sectional study.Scientific reports · 2025Article
- Outcomes and risk factors for functional prognosis at 3 months after intravenous thrombolysis with r-tPA in patients with acute ischemic stroke: a retrospective cohort study.Thrombosis journal · 2025Article
- Cerebral Small Vessel Disease is Associated with Prehospital Delay in Acute Ischemic Stroke.Journal of atherosclerosis and thrombosis · 2025Article
- Observational
- Effect of early neuroendovascular team involvement in acute stroke protocol: a retrospective study.Frontiers in neurology · 2025Article
- Temporal Effects of Disease Signature Genes and Core Mechanisms in the Hyperacute Phase of Acute Ischemic Stroke: A Bioinformatics Analysis and Experimental Validation.Mediators of inflammation · 2025Article
- Time-Sensitive Quality Metrics of Acute Stroke Care: A Comprehensive Stroke Center Experience.The Eurasian journal of medicine · 2024Article
- Delayed door to puncture time during off-duty hours is associated with unfavorable outcomes after mechanical thrombectomy in the early window of acute ischemic stroke.BMC neurology · 2024Article
- Impact of war on stroke incidence in Ivano-Frankivsk, Ukraine.Scientific reports · 2024Article
- Evaluation of Hemoglobin and Eosinophil Count in Patients Receiving Thrombolytic Treatment.Cureus · 2024Article
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Authors and funding
8 authors.
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Abstract
background and purposePrevious studies have reported that early hospital arrival improves clinical outcomes in patients with acute ischemic stroke; however, whether early arrival is associated with favorable outcomes regardless of reperfusion therapy and the type of stroke onset time is unclear. Thus, we investigated the impact of onset-to-door time on outcomes and evaluated the predictors of pre-hospital delay after ischemic stroke.
methodsConsecutive acute ischemic stroke patients who arrived at the hospital within five days of onset from September 2019 to May 2020 were selected from the prospective stroke registries of Seoul National University Hospital and Chung-Ang University Hospital of Seoul, Korea. Patients were divided into early (onset-to-door time, ≤4.5 h) and late (>4.5 h) arrivers. Multivariate analyses were performed to assess the effect of early arrival on clinical outcomes and predictors of late arrival.
resultsAmong the 539 patients, 28.4% arrived early and 71.6% arrived late. Early hospital arrival was significantly associated with favorable outcomes (three-month modified Rankin Scale [mRS]: 0-2, adjusted odds ratio [aOR]: 2.03, 95% confidence interval: [CI] 1.04-3.96) regardless of various confounders, including receiving reperfusion therapy and type of stroke onset time. Furthermore, a lower initial National Institute of Health Stroke Scale (NIHSS) score (aOR: 0.94, 95% CI: 0.90-0.97), greater pre-stroke mRS score (aOR: 1.58, 95% CI: 1.18-2.13), female sex (aOR: 1.71, 95% CI: 1.14-2.58), unclear onset time, and ≤6 years of schooling (aOR: 1.76, 95% CI: 1.03-3.00 compared to >12 years of schooling) were independent predictors of late arrival.
conclusionsThus, the onset-to-door time of≤4.5 h is crucial for better clinical outcome, and lower NIHSS score, greater pre-stroke mRS score, female sex, unclear onset times, and ≤6 years of schooling were independent predictors of late arrival. Therefore, educating about the importance of early hospital arrival after acute ischemic stroke should be emphasized. More strategic efforts are needed to reduce the prehospital delay by understanding the predictors of late arrival.
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