Minutes Mean Months: Getting Stroke Care Fast Is Vital, Study Confirms
For someone suffering a severe stroke, every 10 minutes that goes by before treatment starts in the emergency room may cost eight weeks of a healthy life, Canadian researchers report.
In fact, delays in the hospital may have worse consequences for recovery than delays in getting to the hospital, they noted.
"Our study confirmed that any delay in delivering appropriate stroke treatment is critical," said lead researcher Dr. Mohammed Almekhlafi. He is an assistant professor of clinical neurosciences, radiology and community health sciences at the University of Calgary's Cumming School of Medicine.
"Delays after arrival at the hospital are also important. It may not be enough to only be aware of stroke symptoms and the availability of hospitals that are capable of treating stroke in one's area. The performance of these hospitals in the various time metrics needs to be recognized. Fast delivery of stroke treatment is a right for all stroke victims," he said.
Many national and international stroke associations have suggested benchmarks for the time from arrival at the emergency room until treatment, Almekhlafi said.
"Our findings emphasize the importance of continuously monitoring these time metrics to ensure that the care path speed is optimized," he added.
For their study, Almekhlafi's team reviewed seven previous studies that included a total of 406 patients and were published between 2010 and 2015. The patients took part in trials that compared mechanically removing clots with or without clot-busting drugs versus clot-busting drugs alone.
All of the patients had a severe stroke with blockage of one of the brain's large arteries, and all were treated within four hours after the stroke began.
The investigators found that the median time between the start of symptoms and arrival at the ER was a little over three hours, and the median time between arriving at the ER and the start of a procedure to remove the brain clot was more than 1.5 hours.
The researchers calculated that every hour delay in the hospital resulted in 11 months of healthy life lost.
The research team stressed that quick action to evaluate and treat stroke is critical. Patients need to be rushed to brain imaging to find where the clot is and clot-busting drugs given as quickly as possible. Then, patients need to be rushed to an operating room for endovascular therapy to remove the clot.
Delays can happen if brain scanners or angiography rooms are occupied by another patient or if delays occur in notifying the stroke team, Almekhlafi explained.
Dr. Larry Goldstein, chairman of the department of neurology at the University of Kentucky in Lexington, said, "These data suggest that treatment process delays after hospital arrival -- but not delays between symptom onset reflected in last time [the patient was] known well and hospital arrival -- were associated with poorer outcomes after blood clot removal in patients with stroke."
But Goldstein noted that the entire process -- from recognizing a stroke, getting to the hospital and being diagnosed and treated -- is critical to the outcomes of stroke patients.
"Regardless, recognition of stroke symptoms, rapid activation of the emergency transport system, availability of hospitals capable of rapid stroke diagnosis, and systems to minimize treatment delays and optimize emergent and subsequent stroke-related care processes are all important to increase the likelihood of improving patient outcomes," Goldstein said.
The process begins with believing a stroke has occurred.
One acronym that helps people recognize the symptoms of stroke is BE-FAST, Goldstein said. If someone suddenly develops any of these symptoms, a stroke may be occurring:
- B- Balance or leg weakness
- E- Eyes - visual loss or double vision
- F- Facial droop
- A- Arm weakness
- S- Speech that is slurred or otherwise changed
- T- Time -- the need to call 911 immediately
The findings were scheduled for presentation at the American Stroke Association's virtual annual meeting, March 17 to 19. Research presented at meetings should be considered preliminary until published in a peer-reviewed journal.
For more on stroke, head to the American Stroke Association.
SOURCES: Mohammed Almekhlafi, MD, assistant professor, clinical neurosciences, radiology and community health sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada; Larry Goldstein, MD, professor and chairman, department of neurology, University of Kentucky, Lexington; American Stroke Association, meeting, March 17 to 19, 2021, online