Table 1.
Factors associated with early and delayed hospital arrival after stroke.
| Factors associated with early presentation |
|---|
| Emergency Medical Services admission (40) (30–69) |
| Severe stroke (NIHSS and equivalent) (26) (38, 43, 45, 46, 50, 54, 56, 58, 63–65, 69–83) |
| Hemorrhagic stroke (10) (57, 59, 61, 66, 84–89) |
| Consciousness: lowered, disturbed, lost (9) (41, 49, 61, 81, 85, 90–93) |
| History of stroke or TIA (7) (41, 62, 73, 81, 94–96) |
| History of atrial fibrillation, cardiac arrhythmia (7) (43, 56, 61, 62, 67, 97, 98) |
| Attributing symptoms to stroke (7) (53, 55, 69, 92, 98–100) |
| CAD, IHD, prior myocardial infarction (6) (56, 59, 61, 62, 96, 101) |
| Perception of severity, urgency (6) (32, 43, 47, 52, 53, 100) |
| Speech disturbance, aphasia (6) (41, 44, 52, 57, 102, 103) |
| 911 (or equivalent) called first or early (6) (32, 99, 104–107) |
| Bystander response (5) (32, 47, 49, 58, 99) |
| Not living alone (4) (33, 39, 60, 82) |
| Higher education level (4) (43, 60, 77, 101) |
| TIA (4) (43, 57, 89, 100) |
| Increasing disability (4) (71, 78, 86, 88) |
| Daytime onset (4) (70, 79, 86, 108) |
| Sudden onset of symptoms (3) (39, 71, 99) |
| Reduced GCS (3) (45, 78, 95) |
| Knowledge of thrombolysis (3) (53, 58, 68) |
| Cardioembolic stroke (3) (89, 109, 110) |
| Motor impairment (3) (41, 71, 111) |
| White race/ethnicity (USA) (3) (33, 48, 62) |
| Directly reaching hospital (3) (89, 101, 102) |
| Factors associated with delayed presentation |
| Primary care facility (GP) visited first (14) (34, 59, 61, 68, 85, 90, 112–119) |
| Referral from other hospital (10) (49, 58, 66, 74, 92, 97, 115, 117, 120, 121) |
| Living alone (9) (43, 59, 60, 66, 68, 71, 94, 95, 122) |
| Stroke in the evening or night (8) (40, 59, 66, 82, 85, 92, 104, 122) |
| Diabetes mellitus (7) (52, 55, 56, 61, 62, 67, 92) |
| Private transport to hospital (6) (60, 63, 97, 113, 119, 121) |
| Black race/ethnicity (USA, UK) (5) (54, 56, 82, 123, 124) |
| Lacunar stroke, small vessel stroke (5) (46, 90, 95, 96, 109) |
| Mild neurological symptoms (5) (34, 59, 63, 94, 113) |
| Symptoms not taken seriously, low threat perception (4) (43, 59, 114, 117) |
| Awakening with symptoms (3) (35, 125, 126) |
| Symptom onset at home (3) (61, 97, 104) |
| Regular drinker, history of alcohol abuse (3) (61, 79, 96) |
| Worsening symptoms compared to onset (3) (49, 97, 121) |
Factors significantly associated (P < 0.05) with early hospital arrival after stroke are shown. Factors were included in this table if they were reported as significant in three or more studies. Factors independently associated with early or delayed arrival (multivariate analysis) were included in the list; however, for studies that performed univariate analyses only, these factors are also listed.
The first number in parentheses indicates the number of studies canvassing each factor, followed by the references.
NIHSS, National Institutes of Health Stroke Scale; TIA, transient ischemic attack; CAD, coronary artery disease; IHD, ischemic heart disease; GCS, Glasgow Coma Scale; GP, general practitioner.