• Emeline Laurent, Isabelle Bonnaud, Marie Gaudron, Alexia Lahondère, Lucile Godillon, Sophie Vannier, Guillem Bouilleau, Bertrand De Toffol, Jean-Philippe Cottier, Saïd Laribi, and Leslie Grammatico-Guillon.
• Public Health and Epidemiology Unit (EpiDcliC), Teaching hospital of Tours.
• Eur J Emerg Med. 2022 Feb 1; 29 (1): 566256-62.

Background And ImportanceOptimizing the care pathway of stroke is crucial for the revascularization of ischemic stroke.Objectivesto identify factors associated with (1) a time interval over 4 h between the symptom onset and cerebral imaging in suspected stroke patients and (2) the absence of revascularization in patients with ischemic stroke.Design, Settings And ParticipantsPatients over 18 years old with a suspected stroke admitted in 22 emergency rooms or stroke units in one French region between 1 March 2019 and 30 April 2019 were prospectively included by filling a dedicated form.Outcome Measures And AnalysisFactors associated with the previously mentioned outcome measures were identified using logistic regression models.Main ResultsIn total 991 patients were included; 537 patients (64% of 845 with available time intervals) were admitted more than 4 h after symptom onset. Three predictors were identified: not calling emergency medical services (EMS) [odds-ratio (OR) 5.2; 95% confidence interval (3.4-8.1)], a preexisting autonomy loss [2.0 (1.3-2.9)] and atypical clinical presentation [2.0 (1.3-3.1)]. A total of 385 patients had an ischemic stroke of whom 93 underwent a revascularization procedure (24%). The same three predictors were associated with the absence of revascularization procedure, added to an initial admission in a hospital without stroke unit [3.1 (1.1-8.6)].ConclusionThis study shows that efforts to organize the care chain for stroke need to be intensified in the region to reduce treatment time intervals, which could include information campaigns focused on the impact of EMS call and the clinical presentation recognition.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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