Factors Associated with Delay of Emergency Medical Services Activation in Patients with Acute Stroke

Background: The poor prognosis of acute stroke may be largely attributed to delays in treatment. Emergency medical services (EMS) usage is associated with a significant reduction in the delay in stroke treatment. The aims of this study were to identify factors associated with the delay in EMS activation for patients with acute stroke. Methods: This study was conducted at 26 Fire Safety Centers in five districts of Seoul, Korea. Patients with acute stroke transferred by EMS and admitted to a tertiary referral hospital from January 2014 to December 2018 were enrolled. In this cross-sectional study, the dependent variable was the time from stroke onset to EMS activation time. Patients were divided into two groups, onset-to-alarm time <= 30 min and onset-to-alarm time > 30 min, and previously collected patient data were analyzed. We performed logistical regression analyses of characteristics differing significantly between groups. Results: Out of 480 patients, 197 (41%) had onsetto-alarm times > 30 min. Significant variables in the logistical analysis were alert mental state (adjusted odds ratio [aORI: 2.77; 95% confidence interval [CI]: 1.31-6.13), pre-stroke mRS >= 2 (aOR: 2.46; 95% CI: 1.26-4.95), onset occurrence at private space (aOR: 2.31; 95% CI: 1.23-4.41), recognizing symptoms between 0 and 8 am (aOR: 2.30; 95% CI: 1.25-4.31), ischemic stroke (aOR: 1.88; 95% CI: 1.04-3.43), and witnessed by others (aOR: 0.32; 95% CI: 0.18-0.55). Conclusions: Delay in EMS activation for acute stroke cases is possibly related to difficult situations to recognize stroke symptoms, such as alert mental state, pre-stroke mRS >= 2, onset occurrence at private space, recognizing symptoms between 0 and 8 am, and unwitnessed by others.