Fatores associados ao retardo na chegada ao hospital para pessoas com acidente vascular cerebral

Abstract

Stroke is one of the leading causes of morbidity and mortality, which can be minimized by the early arrival of the affected person at the hospital. However, little is known about prehospital delay and associated factors. To investigate sociodemographic, clinical, and environmental factors associated with delays in hospital arrival for individuals who suffered an ischemic stroke (AVCI). A cross-sectional study was conducted at a High Complexity Neurology Reference Center. Data were collected between March 2019 and February 2021. The sample consisted of 1,289 individuals diagnosed with hemorrhagic or ischemic stroke aged ≥18 years. Those with transient ischemic attacks or other cerebrovascular diseases were excluded. Data were collected from medical records using a specific instrument. The study was approved by the Research Ethics Committee (Opinion CAAE: 55068121.4.0000.5028). Data were analyzed descriptively, using Pearson’s Chi-square or Fisher’s Exact test and the Poisson Regression Model. Statistical significance was set at 5%. The sample predominantly included individuals aged ≥60 years (68.3%), male (50.2%), living with a partner (57.2%), of black race/color (97.4%), from Salvador (81.9%), with hypertension (81.2%), hemiparesis (62.2%), speech impairment (62.1%), facial asymmetry (29.5%), moderate to severe neurological deficit (75.8%), using SAMU-192 (51.6%), and experiencing the event in the morning (45.1%). In multivariate analysis, self-declared brown and black individuals had 1.91 times longer hospital arrival times (HAT) >4.5 hours compared to white, Asian, and indigenous individuals (PR 1.91; 95% CI 1.01–3.60). Those residing in the metropolitan region and other regions of Bahia had, respectively, 1.38 (95% CI 0.95–2.01) and 1.90 (95% CI 1.38–2.62) times more HAT >4.5 hours than those living in Salvador. Regarding transport type, participants using ambulances and private cars had, respectively, 1.97 (95% CI 1.45–2.68) and 1.51 (95% CI 1.15–1.99) times more HAT >4.5 hours compared to those who used SAMU-192. Regarding the severity of the neurological deficit, having an NHISS score of 6–13 and ≥14 reduced HAT >4.5 hours by 35.0% and 48.0%, respectively, compared to a score of 0–5. Participants without hypertension and diabetes had, respectively, 28.0% and 34.0% fewer hospital arrivals >4.5 hours than those with these conditions. Those without atrial fibrillation had 1.58 (95% CI 0.97–2.50) times more HAT >4.5 hours. Regarding stroke signs and symptoms, participants without facial asymmetry and speech impairment had, respectively, 1.23 (95% CI 0.95–1.93) and 1.35 (95% CI 0.95–1.93) more HAT >4.5 hours. There was no association between the stroke occurrence time and HAT, but this variable remained in the model for better adjustment. Variables most associated with HAT >4.5 hours included black race/color, living in areas farther from the neurology reference center, using ambulances and private cars for transportation, having atrial fibrillation, and lacking facial asymmetry and speech impairment. Greater neurological deficit severity and absence of hypertension and diabetes reduced HAT >4.5 hours. The study contributes to the development of health education programs aimed at reducing hospital arrival times and may guide health managers and public policies chrometo expand healthcare service networks.