A shorter system delay for haemorrhagic stroke than ischaemic stroke among patients who use emergency medical service

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For patients with acute stroke, time until initial treatment in hospital may be critical. For each minute that passes in the early chain of care, 1.9 million nerve cells will die.1 For patients in whom brain ischaemia is the cause of stroke, early revascularisation is the most appropriate treatment.2 For patients with a haemorrhage, in most cases, there still is no direct acute treatment, even though interventions such as surgery, reversing oral anticoagulant treatment and lowering of blood pressure may be beneficial in selected cases.6 Therefore, regardless of the aetiology, it is important that the time between the onsets of symptoms until a diagnosis is established is as short as possible. The length of this delay can be divided into patient delay, that is the patient's decision time, and system delay which, for patients calling the dispatch centre for the emergency medical services (EMS), can be defined as the time from first contact until the CT scan.9
A number of factors influence the length of these two types of delay. In essence, they include (i) the severity of symptoms; (ii) the patient's interpretation of the symptoms; (iii) the actions of bystanders; (iv) logistic factors including distance to hospital and EMS availability; (v) the priority given at the dispatch centre; (vi) early recognition by the EMS clinician; (vii) communication between the EMS and the hospital; and finally (viii) early recognition by the first healthcare provider assessing the patient in hospital.
Much information is available about these various factors and how they influence the length of delay.10 However, less is known about eventual differences in various aspects of the early chain of care in acute stroke when patients with a haemorrhagic stroke are compared to patients with an ischaemic stroke. In a previous Swedish multicentre study, the system delay was longer for patients with ischaemic stroke compared to patients with haemorrhagic stroke.11 However, this study was carried out before thrombolysis and trombectomia were introduced as acute treatment alternatives.
The aim of this survey is to describe various aspects in the early chain of care in acute stroke when comparing patients with haemorrhagic stroke to patients with ischaemic stroke. The primary endpoint is the system delay among patients calling the EMS. A major question to address was whether system delay is still prolonged among patients with a non‐haemorrhagic stroke as compared with those with a haemorrhagic stroke despite the introduction of thrombolysis and trombectomia.
Furthermore, we aimed at addressing other aspects of the early chain of care of clinical relevance for the early treatment with a particular emphasis on the early suspicion of stroke. Finally, we describe the subsequent mortality during the early phase and during the subsequent 5 years.

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