Abstract
Recent studies have established the importance of aggressive medical therapy using tissue plasminogen activator for the hyperacute stage of stroke in the USA and Europe Hospital arrival time varies among differ-ent types of stroke and area. We investigated the arrival time after the onset of different types of stroke. The critical factors determining access to acute stroke were examined in each type of stroke. Seikeikai General Hospital is located in the Sakai-city area of Osaka, Japan. A total of 200 sets of data were collected consecutively from the medical records of acute cerebral infarction patients admitted directly to the emer-gency department (ED) during a 2-year period (1998-1999), and divided into three subtypes : lacunar (n = 110) atherothrombotic (n = 50), and cardioembolic (n=40). Forty-one percents arrived within 3 hours. Excluding patients whose symptoms were first noticed on awaking, 26% of patients arrived early within 2 hours and 37% within 3 hours. The median time from the onset to ED arrival in patients witn cardioembolic infarction was 2.8 hours, which was significantly shorter than that in those with lacunar infarction (10.3 hours) or atherothrombotic infarction (7.5 hours) (p<0.01). The frequency of patients arriving at the ED within 3 hours after the onset in lacunar, atherothrombotic, and cardioembolic infarction was 28%, 34%, and 65%, respec-tively. Patients with disturbance of consciousness arrived much sooner after the onset that did those without it (66.7% vs. 32.2%) (p<0.01) . Also, patients with spouses arrived earlier than did those without spouses (45% vs. 31%) (p<0.05). However, there was no significant difference in arrival time between patients with and without a past history of stroke. A "brain attack" education program to increase public knowledge about stroke could contribute to increasing the speed of hospital presentation after the onset of stroke.
