Pre-Hospital and In-Hospital Delay in Acute Ischemic Stroke Patients in Indonesia: A Multi-center Study

  • Surakit Nathisuwan Faculty of Pharmacy, Mahidol University
  • Rizqi Haqqum Minalloh Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
  • Abdulloh Machin
  • Wida Mardiana
  • Thanarat Suansanae
  • Suvatna Chulavatnatol
Keywords: Fibrinolysis, Stroke, Indonesia

Abstract

Introduction: Little is known regarding pre-hospital and in-hospital delays in acute ischemic stroke (AIS) patients in Indonesia. This study aimed to evaluate the nature of these delays and identify factors causing pre-hospital delays among AIS patients in Indonesia.
Methods: This was a prospective, observational study conducted among adult AIS patients in 3 hospitals in Surabaya during March–August 2019. Baseline characteristics along with time intervals both pre- and post-arrival of patients to the study sites were collected and analysed. Multiple logistic regression analyses with a stepwise forward model were performed to evaluate the factors contributing to the pre-hospital delay.
Results: A total of 126 patients were recruited in this study. Mean age ± S.D. was 58.56 ± 10.71 years old. The mean ± S.D. time of pre-hospital delay and mean ± S.D. time to computerized tomography scan were 1,004±1,116.09 and 189±166.44 minutes, respectively. Only 18 out of 126 patients (14.29%) presented to the hospitals within 4.5-hour of intravenous thrombolysis (IVT) time window. However, only 3 patients (2.38%) ultimately received IVT. Wake-up stroke (OR=17.865; p=0.019), unawareness of the gravity of symptoms (OR=11.025; p=0.007), unawareness of stroke symptoms (OR=7.880; p=0.003) and referral patient (OR=7.819; p=0.008) were significantly associated with pre-hospital delay.
Conclusion: Pre-hospital delay of AIS was very common and represented a challenging problem to improve stroke care in Indonesia. Wake-up stroke along with lack of patient understanding in recognizing stroke symptoms and ineffective referral system were the most prominent risk factors for pre-hospital delay in Indonesian AIS patients.

Author Biographies

Abdulloh Machin

Department of Neurology, Dr. Soetomo General Hospital, Surabaya, Indonesia

Department of Neurology, Universitas Airlangga Hospital, Surabaya, Indonesia

Wida Mardiana

Department of Neurology, Hajj General Hospital, Surabaya, Indonesia

Thanarat Suansanae

Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand

Suvatna Chulavatnatol

Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand

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Published
2022-04-22
How to Cite
Nathisuwan, S., Minalloh, R. H., Machin, A., Mardiana, W., Suansanae, T., & Chulavatnatol, S. (2022). Pre-Hospital and In-Hospital Delay in Acute Ischemic Stroke Patients in Indonesia: A Multi-center Study . Indonesian Journal of Pharmacy, 33(2). https://doi.org/10.22146/ijp.2036
Section
Research Article