Recently, a cross-sectional study on prehospital delays among the stroke population in China, based on the Bigdata Observatory Platform for Stroke of China (BOSC), has been published online in The Lancet Regional Health -Western Pacific. This is the first study to report variations in prehospital delays according to age, rurality, and province using a national prospective multicenter registry. This research was undertaken in collaboration with Dr. Jing Yuan from the School of Pharmacy, Prof. Jing Zhao from the affiliated Minhang Hospital, and other researchers from the General Office of Stroke Prevention Project Committee of the National Health Commission of the People's Republic of China, the Perelman School of Medicine of the University of Pennsylvania, the University of South Carolina, and the University of Tennessee.
Acute ischemic stroke (AIS) refers to the necrosis or softening of localized brain tissue caused by cerebral blood circulation disorders and is characterized by high disability, mortality, and recurrence rates. AIS is one of the leading causes of death in theadult population in China. In recent years, the incidence and prevalence of AIS in China have exhibited an upward trend, exacerbating the overall disease burden. The primary focus of treatment is thetimely revascularization of the infarcted brain area to reduce brain tissue necrosis and restore cellular function. Intravenous thrombolysis, if administered within three hours after the onset, is the most recommended revascularization method; it can be extended to 4.5 hours for patients fulfilling particular standards. Another recommendation for revascularization is mechanical thrombectomy within six hours of onset. To minimize prehospital delays, China has invested in the establishment of stroke centers and implemented green channels for timely diagnosis and treatment of stroke. Significant progress has been made in reducing the delay between the onset of stroke symptoms and receipt of medical care.
The study divided onset-to-door (OTD) delays into time frames of <3.0 hours, 3.0–5.9 hours, 6.0–11.9 hours, 12.0–23.9 hours, 24.0–47.9 hours, 2–7 days, with the OTD time and the admission rate as primary outcomes coinciding with first three crucial hours after onset. Data from the Bigdata Observatory Platform for Stroke of China (BOSC), a national, prospective, multicenter registry, were used in this study. A total of 78,389 patients within seven days of stroke onset were included and categorized into subgroups based on various factors, including sex, age, province, geographic region, rurality, stroke severity, onset time (day or night, workdays, or weekends), mode of transportation, and patient source. The OTD time and admission rate within three hours of onset were both qualitatively and quantitatively analyzed for each subgroup (figure below).
The results showed that the median OTD time of stroke populations in China was as high as 23.83 hours and only one in every ten patients were able to arrive at the hospital within the "golden" three hours. Young/middle-aged patients (18–64 years) had a significantly longer OTD time than patients aged 65 years or older and were less likely to present to hospitals within three hours of onset. The OTD time was longer in females than in male patients, but showed no significant difference. Among the seven geographic areas of China, patients living in the northwest region, specifically in Gansu, had the lowest 3-hour hospital arrival rate, with only 3.45% of patients being admitted within 3 hours. Beijing topped nationwide with a 3-hour arrival rate of 18.40%. Additionally, the 3-hour arrival rate in urban areas was twice as high as that in rural areas across the country.
Currently, the 3-hour hospital arrival rate in China is only approximately one-fifth of that in Europe and the United States. Most stroke patients are unable to receive prompt medical care, particularly young or middle-aged patients, residents of rural areas or less developed regions. This study emphasizes the need for increased attention to the treatment of stroke among the younger generation, and inhabitants of rural areas, and economically disadvantaged geographic regions. This study utilized 2020 data from the BOSC registry, providing a comprehensive analysis of regional and age-associated disparities in stroke treatment across the country, filling a research gap in the field of prehospital delays.
Dr. Jing Yuan is the first author of the paper, and Academician Long-De Wang of the Chinese Academy of Engineering, Prof. Yu-Ren Liu, and Prof. Jing Zhao are corresponding authors. This study was supported by the National Natural Science Foundation of China.
Full-text link：https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(23)00011-1/fulltext
