Time to hospital admission and start of treatment in patients with ischemic stroke in northern italy and predictors of delay

Simone Vidale, Ettore Beghi, Francesca Gerardi, Claudio De Piazza, Silvia Proserpio, Marco Arnaboldi, Giacomo Bezzi, Giorgio Bono, Giampiero Grampa, Mario Guidotti, Patrizia Perrone, Daniele Porazzi, Davide Zarcone, Alberto Zoli, Elio Agostoni

Research output: Contribution to journalArticlepeer-review


Background and Purpose: Early treatment (i.e. thrombolysis) is crucial for a successful care of ischemic stroke. In the management of stroke, two phases are crucial: the pre-hospital and the in-hospital interval. This work investigated factors influencing pre- and in-hospital delay in a large geographic area of Northern Italy. Methods: Enrolled were patients presenting with ischemic stroke in four administrative districts of Northern Italy (Como, Lecco, Sondrio and Varese) over a 4-month period. Pre-hospital time and in-hospital time with single management steps were recorded prospectively. Age, gender, recruiting hospital, EMS transport and triage codes, clinical severity and thrombolytic treatment were also recorded. Univariate and multivariate analysis of factors predicting pre- and in-hospital delay were performed. Results: Median pre-hospital time and in-hospital time were, respectively, 120 min (interquartile range, IQR 62-271) and 150 min (IQR 80-214). Pre-hospital time was halved in patients hospitalized via EMS (p <0.001) and clinically more severe (p <0.001). At multivariate analysis, transport code was associated with delay at any time (p <0.05). Conclusions: EMS use and transport code predicted treatment delay in patients with ischemic stroke. A more intensive use of EMS and high urgency codes could help increase the number of stroke patients treated appropriately.

Original languageEnglish
Pages (from-to)349-355
Number of pages7
JournalEuropean Neurology
Issue number5-6
Publication statusPublished - 2013


  • In-hospital delay
  • Pre-hospital delay
  • Stroke
  • Stroke management

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Medicine(all)


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