The DETECT Stroke Study: A Cross-Sectional Evaluation of Emergency Treatment Delays in Stroke Patients
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Abstract
Background: The DETECT study explored factors causing delayed hospital arrival for non-Fast Track stroke patients in rural Thailand, recognizing that early arrival is critical for optimal stroke outcomes.
Objective: To investigate factors contributing to delayed hospital arrival and analyze clinical outcomes in rural Thai stroke patients.
Methods: A cross-sectional study analyzed 216 stroke patients at Surin Hospital during 2021, comparing early (<4.5 hours, n=92) versus delayed (≥4.5 hours, n=124) arrival groups. Multivariate analysis examined demographic, socioeconomic, transportation, and behavioral factors.
Results: 57.4% of patients arrived after the 4.5-hour window. Factors significantly associated with delayed arrival included: Lower education level (OR 2.45, p=0.010), Greater distance from hospital (20.89±24.66 vs 13.87±10.54 km, p=0.011), Use of Emergency Medical Services was significantly lower in delayed arrivals (9.1%) compared with early arrivals (17.4%, p=0.004), Wait-and-see behavior (61.7% vs 41.0%, p=0.008). Early arrivers showed significantly better functional outcomes in Barthel Index (8.35-point improvement, p=0.021) and Modified Rankin Scale (0.52-point reduction, p=0.002).
Conclusion: The study identified four modifiable factors affecting pre-hospital delay in rural Thai stroke patients. Findings suggest implementing targeted community education, enhancing rural EMS accessibility, and developing telemedicine solutions could reduce pre-hospital delays and improve outcomes.
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