Deans' stroke musings: Determinants of the time period from stroke onset to arrival at the emergency department: a GIS integrated hospital-based cross-sectional study

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Sunday, April 13, 2025

Determinants of the time period from stroke onset to arrival at the emergency department: a GIS integrated hospital-based cross-sectional study

Time to arrival is NOT A VALID EXCUSE for not getting survivors 100% recovered! My God, you'll use anything to deflect your responsibility to get survivors fully recovered! In the business world, running away from problems gets you fired!

Determinants of the time period from stroke onset to arrival at the emergency department: a GIS integrated hospital-based cross-sectional study

Scientific Reports volume 15, Article number: 12726 (2025) Cite this article

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Abstract

Stroke is a serious public health problem in developing countries like India, leading to rising deaths and disability-adjusted life years related to stroke. Pre-hospital delay is a major concern in most acute stroke cases, affecting timely interventions and treatment outcomes. Hence the current study aimed to identify the factors influencing the time from stroke onset to arrival at the emergency department and to map the spatial distribution of stroke cases from the tertiary care hospital. We conducted a hospital-based cross-sectional study among stroke patients presenting to the emergency department of a tertiary care hospital in Mysuru. Data on sociodemographic, clinical, and pre-hospital factors, along with detailed addresses of the place of stroke onset, first and second consultation, and their proximal first referral units were collected. GIS mapping was done using the software ArcGIS v10.8.2, and statistical analysis was performed using SPSS v25. Most of the study participants were men, over 60 years of age, and residents from rural areas of Mysuru and its neighboring districts. The study found that only 25% of the stroke cases arrived within 4.5 h of symptom onset, with hemiparesis and slurred speech being the most common presenting complaints. Almost all the cases were within a 20 km radius of the first referral units with factors such as age group (p = 0.028), diabetes as a comorbid condition (p = 0.007), the decision taken for symptom onset (p < 0.01), the person involved in decision-making (p = 0.006), and the mode of arrival at the hospital (p = 0.004) being significantly associated with the duration from stroke onset to arrival at the hospital. This highlights the need for public awareness campaigns on stroke symptoms, the importance of early hospital presentation following stroke onset, and the capacity building of first referral units to provide timely emergency stroke care(NOT RECOVERY!) for people residing in rural areas.

Introduction

“Stroke is a syndrome of rapidly developing signs and symptoms of focal loss of cerebral function, caused by the sudden death of brain cells due to impaired blood flow to the brain.” It is a common non-communicable disease globally, contributing to morbidity, mortality, and financial burden to health systems¹. Stroke is the leading cause of disability and the second leading cause of death worldwide². As per the global fact sheet 2022, the lifetime risk of having a stroke has increased by 50% over the last 17 years, with one in every four individuals expected to suffer a stroke during their lifetime. A report from the World Stroke Organization and Lancet Neurology Commission projects stroke deaths will rise from 6.6 million in 2020 to 9.7 million by 2050, with low-and middle-income countries accounting for 86% of deaths and 89% of disability-adjusted life years (DALYs) related to stroke globally³.

In developing countries like India, stroke has become a serious public health problem due to the increasing prevalence of behavioral risk factors and sedentary lifestyles, contributing to rising incidence, deaths, and DALYs. In India, stroke is the fourth leading cause of death and the fifth leading cause of disability, with an estimated annual incidence of 105–152/100,000 population⁴.

The main pathological types of stroke include cerebral infarction, primary intracerebral hemorrhage, and subarachnoid hemorrhage. In most cases, ischemic stroke develops gradually while hemorrhagic stroke occurs suddenly. Stroke diagnosis is based on a comprehensive clinical examination, detailed history, and brain imaging through computed tomography (CT) or magnetic resonance imaging (MRI)⁵.

Treatment following a stroke is crucial, as the time to treatment significantly impacts the effectiveness of acute stroke therapies and patient outcomes⁶. Early hospital arrival allows for prompt medical intervention, leading to better outcomes⁷. The duration from stroke onset to arrival at the hospital depends on factors such as the ability to recognize the symptoms, timely transportation, referral, accurate diagnosis, and quick medical intervention. Pre-hospital delays are a major concern in many acute stroke cases, as they affect timely treatments like intravenous thrombolysis and mechanical interventions, ultimately affecting treatment outcomes^6,8,9.

The Government of India has launched the “National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke” (NPCDCS) to address the rising burden of non-communicable diseases, including stroke¹⁰. This program emphasizes early detection and management of stroke using stroke care(NOT RECOVERY!) algorithms across healthcare facilities, from primary health centers to district hospitals. However, gaps remain in stroke care(NOT RECOVERY!), especially in rural areas, leading to delayed hospital presentations¹¹.

There is a fundamental relationship between geography and access to emergency care(NOT RECOVERY!) during a crisis. Geographic information systems and spatial data can be utilized to enhance equitable resource allocation and improve access to emergency medical services, particularly for people living in remote and rural areas, by considering the geographic distribution of cases and the availability of emergency-ready healthcare facilities^12,13.

Hence the current study aims to describe the clinical profile of stroke patients at a tertiary care(NOT RECOVERY!) hospital in Mysuru, identify factors affecting the time from stroke onset to hospital arrival, and map the spatial distribution of stroke cases and the first referral units in the study area.