In-Hospital Emergency Treatment Delay Among Chinese Patients with Acute Ischaemic Stroke: Relation to Hospital Arrivals and Implications for Triage Pathways

Figures & data

Table 1 Characteristics of All Subjects in the Study

Characteristics	Ambulance Arrivals (n = 263)	Walk-In Arrivals (n = 1013)	Total (N = 1276)	χ^2	P value
Sex, n (%)				1.345	0.246
Male	161 (61.22)	580 (57.30)	741 (58.09)
Female	102 (38.78)	433 (42.70)	535 (41.91)
Age (years), n (%)				7.843	0.049
20–39	6 (2.28)	15 (1.46)	21 (1.63)
40–59	71 (27.00)	201 (19.84)	272 (21.30)
60–79	133 (50.57)	553 (54.57)	686 (53.76)
80 and above	53 (20.15)	244 (24.12)	297 (23.31)
Mean ± SD (Mean age, years)	67.02 ± 13.52	69.14 ± 12.67	68.70 ± 12.87
Education, n (%)				34.062	< 0.001
Illiteracy	55 (20.91)	350 (34.53)	405 (31.76)
Primary school	108 (41.06)	267 (26.36)	375 (29.36)
Junior secondary school	55 (20.91)	178 (17.61)	233 (18.28)
Senior secondary school	22 (8.37)	140 (13.81)	162 (12.70)
College and above	23 (8.75)	78 (7.68)	101 (7.90)
Marital status, n (%)				4.007	0.135
Single	5 (1.90)	21 (2.04)	26 (2.01)
Married	245 (93.16)	967 (95.43)	1212 (94.97)
Divorced or others	13 (4.94)	26 (2.53)	39 (3.02)
Residence, n (%)				217.445	< 0.001
Lower SES	130 (49.43)	102 (10.07)	230 (18.18)
Higher SES	133 (50.57)	911 (89.93)	1046 (81.82)
Medical insurance, n (%)				101.305	< 0.001
PEMI	7 (2.66)	49 (4.86)	56 (4.39)
MIE	41 (15.59)	422 (41.63)	463 (36.28)
MIR	1 (0.38)	25 (2.43)	26 (2.04)
RCMI	3 (1.14)	50 (4.96)	53 (4.15)
CHI	2 (0.76)	12 (1.17)	14 (1.10)
Out-of-pocket payment	209 (79.47)	455 (44.95)	664 (52.04)
Number of symptoms, n (%)				0.123	0.940
1	134 (50.95)	517 (51.07)	651 (51.04)
2	81 (30.80)	319 (31.52)	400 (31.37)
3 and above	48 (18.25)	176 (17.41)	224 (17.58)
Clinical severity, n (%)				4.609	0.032
Critical or urgent	122 (46.39)	396 (39.11)	518 (40.59)
Non-urgent	141 (53.61)	617 (60.89)	758 (59.41)
In-hospital emergency treatment started, n (%)				12.758	< 0.001
≤ 1 hour	48 (18.25)	296 (29.22)	344 (26.96)
> 1 hour	215 (81.75)	717 (70.78)	932 (73.04)
Survival outcome, n (%)				2.316	0.128
Death	4 (1.52)	6 (0.58)	10 (0.77)
Survival	259 (98.48)	1007 (99.42)	1266 (99.23)

Abbreviations: SD, standard deviation; SES, socio-economic status; PEMI, public expense medical insurance; MIE, medical insurance for employees; MIR, medical insurance for residents; RCMI, rural cooperative medical insurance; CHI, commercial health insurance.

Table 2 Time Taken on In-Hospital Emergency Treatment Procedures Among Stroke Patients in the Study Compared with the NINDS Standard Time

Procedures	Time Taken Among All Subjects in the Study, Minutes	US NINDS Goals for Time Frames, Minutes	Z Score
Door to vital signs monitoring	16.0 (7.0–29.5)	≤10.0	9.314*
Door to medical history collection	17.0 (7.0–30.0)	≤10.0	9.974*
Door to physical examination	17.5 (7.0–32.0)	≤10.0	10.428*
Door to cardiac monitoring	8.0 (4.0–21.0)	≤10.0	7.569*
Door to ECG examination	17.0 (7.0–66.0)	≤10.0	14.594*
Door to blood samples taken	27.0 (8.0–75.0)	≤10.0	21.074*
Door to neurological evaluation	61.0 (31.0–104.0)	≤15.0	25.079*
Door to initiation of brain imaging	38.0 (19.0–135.0)	≤25.0	17.987*
Door to interpretation of brain imaging report	70.0 (36.0–207.0)	≤45.0	19.529*
Door to treatment initiation	86.0 (59.0–134.0)	≤60.0	20.427*

Notes: Data were presented as median (25th −75th percentile). *P values <0.001 for all Z score tests.

Abbreviations: ECG, electrocardiogram; NINDS, National Institute of Neurological Disorders and Stroke.

Table 3 Time Taken on In-Hospital Emergency Treatment Procedures Between Ambulance Arrivals and Walk-in Arrivals Among Patients Admitted with Acute Ischaemic Stroke in the Study

Procedures	Ambulance Arrivals, Minutes	Walk-In Arrivals, Minutes	P value
Door to vital signs monitoring	17.0 (8.0–30.5)	16.0 (7.0–29.75)	0.077
Door to medical history collection	16.5 (9.25–28.25)	17.0 (7.0–30.0)	0.130
Door to physical examination	16.0 (6.0–30.5)	19.0 (7.0–32.0)	0.187
Door to cardiac monitoring	7.0 (4.0–24.0)	10.0 (6.0–21.0)	0.391
Door to ECG examination	8.0 (4.0–37.25)	21.0 (8.0–76.0)	0.033
Door to blood samples taken	17.0 (6.0–52.0)	30.0 (10.0–82.0)	0.001
Door to neurological evaluation	51.5 (31.0–87.0)	66.5 (31.0–112.0)	0.004
Door to initiation of brain imaging	22.0 (13.0–57.0)	46.0 (21.25–157.75)	< 0.001
Door to interpretation of brain imaging report	39.0 (30.25–114.5)	56.0 (28.0–191.0)	< 0.001
Door to treatment initiation	87.0 (67.0–131.0)	85.0 (53.0–134.0)	0.018

Note: Data were presented as median (25th −75th percentile).

Abbreviation: ECG, electrocardiogram.

Figure 1 In-hospital emergency treatment procedures of stroke patients based on the time taken on in-hospital emergency treatment compared with the NINDS standard time.

Table 4 Factors Associated with In-Hospital Emergency Treatment Delay

Variables	aOR	95% CI	P value
Sex
Male	Ref
Female	1.083	0.831–1.412	0.554
Age (years)
20–39	Ref
40–59	1.396	0.504–3.863	0.521
60–79	1.472	0.539–4.018	0.451
80 and above	1.757	0.623–4.954	0.286
Education
Illiteracy	Ref
Primary school	1.222	0.869–1.718	0.249
Junior secondary school	1.138	0.774–1.672	0.511
Senior secondary school	0.904	0.592–1.381	0.641
College and above	0.877	0.530–1.452	0.611
Marital status
Single	Ref
Married	1.536	0.665–3.548	0.315
Divorced or others	1.761	0.548–5.658	0.342
Residence
Lower SES	Ref
Higher SES	1.821	1.251–2.650	0.002
Medical insurance
With social medical insurance	Ref
Out-of-pocket payment	2.323	1.764–3.060	<0.001
Number of symptoms
1	Ref
2	1.174	0.878–1.570	0.280
3 and above	1.141	0.787–1.654	0.487
Clinical severity
Critical or urgent	Ref
Non-urgent	1.023	0.788–1.328	0.865
Hospital admission pathways
Walk-in arrivals	Ref
Ambulance arrivals	1.744	1.185–2.566	0.005

Abbreviations: aOR, adjusted odds ratio; CI, confidence interval; SES, socio-economic status.