Publication: Feasibility study of acute thrombolytic therapy for stroke in a tertiary care center in Nepal
Date
2018
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Institute of Medicine
Abstract
Abstract
Introduction: Early thrombolysis is the recommended therapy for acute ischemic stroke (AIS). In a developing country like Nepal, many factors contribute to the delay in performing prompt thrombolysis. This was a feasibility study to assess the determinants of pre-hospital delay for patients diagnosed with AIS.
Methods: From 16th July to 16th September 2017, patients diagnosed with AIS in the emergency department (ED) were identified and a structured interview with the patient or next of kin was performed. Various pre-hospital time intervals and possible factors resulting in delay were assessed.
Results: A total of 58 AIS patients were studied. Only 12% of the total patients underwent thrombolysis. The mean delay (+/-sd) from symptom onset to first contact with a medical personnel was 6.74 (+/- 7.84) hours. The mean (+/-sd) total arrival delay to ED was 15.78 (+/-17.48) hours. The mean (+/-sd) delay in dispatch to delivery time was 9.12 (+/-15.57) hours. Ten patients (17%) arrived to our ED within 3 hours of onset of symptoms, and 14 (24%) arrived within 4.5 hours of onset of symptoms. Fifty percent of those who presented on time for thrombolysis underwent the therapy.
Conclusions: This study shows that there are major obstacles before we are able to provide adequate thrombolysis services for AIS. There remain plenty of areas where the government, the hospital and public health services need immediate addressing.
Key words: feasibility, ischaemic stroke, pre-hospital delay, thrombolysis
Description
Pradhan S1, Shrestha PS2, Acharya SP2, Prasad PN3
1Department of Critical Care Medicine, Institute of Medicine
2Department of Anaesthesiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
3Department of Emergency and General Practice, Campus chief, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
Keywords
feasibility, ischaemic stroke, pre-hospital delay, thrombolysis