4. Result
4.3 Deterioration, Barthel Index and mRS Associated with The Arrival Time
Tables 15 and 16 are the comparison for the association of the arrival time with two hours and patients with deterioration. Tables 17 and 18 are the comparison for the association of the arrival time with three hours and patients with deterioration.
According to the Tables 15 and 17, the p-values are not rejected to the null hypothesis at level α=0.05. We conclude that the patients with or without deterioration is not associated with the arrival time groups. According to the Tables 16 and 18, the p-values of are all not significant for the patient with different deteriorations at level α=0.05. We conclude that patient with different deteriorations are not associated with the arrival groups.
Tables 19 and 20 show the proportions of two arrival time groups which one is less than two hours and another one is over two hours for patients with different deteriorations. Tables 21 and 22 show the proportions of two arrival time groups which one is less than three hours and another one is over three hours for patients with deterioration. According to the Tables 19 and 21, the p-values are all not small enough to reject the null hypothesis at level α=0.05. We conclude that the proportion of arrival time less than two or three hours is not difference from the proportion of arrival time over than two or three hours for patient with deterioration. According to the Tables 20 and 22, the p-values are all not small enough to reject the null hypothesis at level α=0.05. We conclude that the two proportions of two arrival time groups are all different for patient with different deterioration.
Table 23 and Figure 1 show the means of Barthel index of two arrival time groups which one is less than two hours and another one is over two hours for the difference
21
of two stages. Table 24 and Figure 2 show the means of Barthel index of two arrival time groups which one is less than three hours and another one is over three hours for the difference of two stages. According to the Tables 23 and 24, the p-values are all not small enough to reject the null hypothesis at level α=0.05. We conclude that the mean of arrival time less than two or three hours is not different to the mean of arrival time over than two or three hours for the difference of two stages.
Table 25 and Figure 3 show the means of mRS of two arrival time groups which one is less than two hours and another one is over two hours for the difference of two stages. Table 26 and Figure 4 show the means of mRS of two arrival time groups which one is less than three hours and another one is over three hours for the difference of two stages. But according to the Tables 25 and 26, only the p-value for patient from one month after stroke to three month after stroke is small enough to reject the null hypothesis at level α=0.05. We conclude that the means of arrival time groups are different only depend on the two stages for patient from one month after stroke to three months after stroke.
22
5. Conclusion
We find out the arrival way that patient call the ambulance by EMS (119) has the shortest arrival time. We also find out the arrival way that patient sent to the hospital by 119 has the largest NIHSS score (severity), followed by patient transformed from other hospital, sent by other people and arrived hospital by themselves.
The arrival time depends on the patient with or without consciousness disturbance.
It also depends on the patient with or without dyslipidemia or diabetes mellitus. But it does not depend on the patient with or without different deteriorations. There is also a difference of the proportions between two arrival time groups. One is less than two or three hours and another one is over two or three hours for the patient with the dependent factors.
For the relationship of the arrival time and prognostic, the arrival time does not depend on the difference of prognostic for two stages with the Barthel index. But the arrival time depends on the difference of prognostic between the mRS of patient with stroke after one month and the mRS of patient with stoke after three months.
23
References
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[2] 行政院衛生署網站 (2007)。http://www.doh.gov.tw/statistic/index.htm。
[3] Hu, H.-H., Sheng, W.-Y., Chu, F.-L., et al. (1992), “Incidence of stroke in Taiwan.”, Stroke, 23:1237-1241.
[4] Debra KM, Laura PK, Mark JA, et al. ( 006), “Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: A scientific statement from the American heart association council on cardiovascular Nursing and stroke coucil”, Circulation, 114:168-182.
[5] Fang, J., Yan, W., Jiang, G.- ., et al. ( 0 ), “Time interval between stroke onset and hospital arrival in acute ischemic stroke patients in hanghai, China”, Clinical Neurology and Neurosurgery, 113:85-88.
[6] Tan, T.-Y., Chang, K.-C. and Liou, C.-W. (2002), “Factors delaying hospital arrival after acute stroke in southern Taiwan”, Chang Gung Medicine, 25:458-463.
[7] Chang, K.-C., Tseng, M.-C., Tan, T.-Y. (2004), “Prehospital Delay After Acute Stroke in Kaohsiung, Taiwan”, Stroke, 35:700-704.
[8] Inatomi, Y., Yonehara, T., Hashimoto, Y., et al. (2008), “Pre-hospital delay in the use of intravenous rt-PA for acute ischemic stroke in Japan”, The Journal of Neurological Sciences, 270:127-132.
[9] Hankey GJ, Jamrozil, Broadhurst RJ et al. (2000), “Five-year survival after first-ever stroke and related prognostic”, Stroke, 31:2080-2086.
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[10] Brott, TG, Adams HP, Olinger CP, et al. (1989), “Measurements of acute cerebral infarction: a clinical e amination scale.”, Stroke, 20:864-870.
[11] Hyung, J.-K., Jung, H.-A., Sun, H.-K., et al. (2011), “Factors associated with prehospital delay for acute stroke in Ulsan, Korea”, The Journal of Emergency Medicine, 41:59-63.
[12] Yuko, T., Makoto, N., Teruyuki, H., et al. (2009), “Factors influencing pre-hospital delay after ischemic stroke and transient ischemic attack”, Internal Medicine, 48:1739-1744.
[13] Lee, H.-C., Chang, K.-C., Lan, C.-F., et al. (2008), “Factors associated with prolonged hospital stay for acute stroke in Taiwan”, Acta Neurologica Taiwanica, 17:17-25.
[14] Kim, Y.-S., Park, S.-S. Bae, H.-J., et al. (2011), “ troke awareness decreases prehospital delay after acute ischemic stroke in korea”, BMC Neurology, 11:2.
[15] Jerrold, H. Zar. (2009). Biostatistical Analysis, Fifth Edition. Pearson International Edition.
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25
Table 1. Analyses of the means of NIHSS score for the six pairs of the arrival ways.
Arrival Way Sample Arrive to the hospital by patients
themselves
Other people escort patient to the hospital
37 3.84 3.06
0.0013
652 5.56 5.17
Arrive to the hospital by patients themselves
Transform from other hospital
37 3.84 3.06
<0.0001
75 10.05 7.32
Arrive to the hospital by patients themselves
Called an ambulance by EMS
37 3.84 3.06
<0.0001
83 12.88 8.84
Other people escort patient to the hospital
Transform from other hospital
652 5.56 5.17
<0.0001
75 10.05 7.32
Other people escort patient to the hospital
Called an ambulance by EMS
652 5.56 5.17
<0.0001
83 12.88 8.84
Transform from other hospital Called an ambulance by EMS
75 10.05 7.32
0.0156
83 12.88 8.84
26
Table 2. Analyses of the means of arrival time for the six pairs of the arrival ways.
Arrival Way Sample Arrive to the hospital by patients
themselves
Other people escort patient to the hospital
20 653.45 657.74
0.4022 302 599.17 963.43
Arrive to the hospital by patients themselves
Transform from other hospital
20 653.40 657.74
0.7940
47 901.57 1796.98
Arrive to the hospital by patients themselves
Called an ambulance by EMS
20 653.40 657.74
0.0470
51 329.45 746.01
Other people escort patient to the hospital
Transform from other hospital
302 599.17 963.43
0.8678
47 901.57 1796.98
Other people escort patient to the hospital
Called an ambulance by EMS
302 599.17 963.43
0.0126
51 329.45 746.01
Transform from other hospital Called an ambulance by EMS
47 901.57 1796.98
0.0235
51 329.45 746.01
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Table 3. The comparison for the association of the arrival time within two hours and patients with symptom or sign during onset.
Variable, n
The arrival time
Total P-value
≦2 hours ＞2 hours
S/S during onset
Yes 93 143 236
0.0215
No 55 139 194
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Table 4. The comparison for the association of the arrival time within two hours and patients with different symptoms or signs during onset.
Variable, n
* By using the Fisher exact test.
29
Table 5. The comparison for the association of the arrival time within three hours and patients with symptoms or signs during onset.
Variable, n
The arrival time
Total P-value
≦3 hours ＞3 hours
S/S during onset
Yes 124 112 236
0.0013
No 74 120 194
30
Table 6. The comparison for the association of the arrival time within three hours and patients with different symptoms or signs during onset.
Variable, n
* By using the Fisher exact test.
31
Table 7. The comparison for the proportions of two arrival time groups which one is less than two hours and another one is over two hours for patients with symptom or sign during onset.
Variable, n (%)
The arrival time
P-value
≦2 hours (n=148) ＞2 hours (n=282)
S/S during onset 93 (62.8) 143 (50.7) 0.0073
Table 8. The comparison for the proportions of two arrival time groups which one is less than two hours and another one is over two hours for patients with different symptoms or signs during onset.
Variable, n (%)
The arrival time
P-value
≦2 hours (n=148) ＞2 hours (n=282)
Headache 6 (4.1) 15 (5.3) 0.2735
Consciousness disturbance 38 (25.7) 23 (8.2) <0.0001
Vomiting 14 (9.5) 15 (5.3) 0.0662
Dizziness 49 (33.1) 104 (36.9) 0.2169
Vertigo 1 (0.7) 6 (2.1) 0.0918
Delirium 0 (0) 1 (0.4) 0.1582
Seizure 2 (1.4) 3 (1.1) 0.3995
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Table 9. The comparison for the proportions of two arrival time groups which one is less than three hours and another one is over three hours for patients with symptom or sign during onset.
Variable, n (%)
The arrival time
P-value
≦3 hours (n=148) ＞3 hours (n=282)
S/S during onset 124 (83.8) 112 (39.7) 0.0013
Table 10. The comparison for the proportions of two arrival time groups which one is less than three hours and another one is over three hours for patients with different symptoms or signs during onset.
Variable, n (%)
The arrival time
P-value
≦3 hours (n=148) ＞3 hours (n=282)
Headache 8 (5.4) 13 (4.6) 0.2239
Consciousness disturbance 44 (29.7) 17 (6.0) <0.0001
Vomiting 16 (10.8) 13 (4.6) 0.1565
Dizziness 69 (46.6) 84 (29.8) 0.3846
Vertigo 2 (1.4) 5 (1.8) 0.1678
Delirium 0 (0) 1 (0.4) 0.1581
Seizure 3 (2.0) 2 (0.7) 0.2688
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Table 11. The comparison for the association of the arrival time within two hours and patients with different risk factors.
Variable, n
The arrival time
Total P-value
≦ 2 hours ＞2 hours
Hypertension Yes 121 245 366 0.2112
No 25 34 59
Dyslipidemia Yes 48 125 173 0.0267
No 86 135 221
Diabetes Mellitus Yes 43 128 171 0.0011
No 102 146 248
Previous CVA Yes 45 92 137 0.6986
No 102 187 289
Previous TIA Yes 4 4 8 *0.4533
No 142 278 420
Smoking Yes 44 97 141 0.4295
No 91 164 255
* By using the Fisher exact test.
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Table 12. The comparison for the association of the arrival time within three hours and patients with different risk factors.
Variable, n
The arrival time
Total P-value
≦ 3 hours ＞3 hours
Hypertension Yes 163 203 366 0.2124
No 32 27 59
Dyslipidemia Yes 68 105 173 0.0489
No 110 111 221
Diabetes Mellitus Yes 66 105 171 0.0091
No 129 119 248
Previous CVA Yes 63 74 137 0.9226
No 133 156 289
Previous TIA Yes 5 3 8 *0.4784
No 191 229 420
Smoking Yes 61 80 141 0.6375
No 118 137 255
* By using the Fisher exact test.
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Table 13. The comparison for the proportions of two arrival time groups which one is less than two hours and another one is over two hours for patients with different risk factors.
Variable, n (Total, %)
The arrival time
P-value
≦2 hours ＞2 hours
Hypertension 121 (146, 82.9) 245 (279, 87.8) 0.0900
Dyslipidemia 48 (134, 35.8) 125 (260, 48.1) 0.0089
Diabetes Mellitus 43 (145, 29.7) 128 (274, 46.7) 0.0002
Previous CVA 45 (147, 30.6) 92 (279, 33.0) 0.3087
Previous TIA 4 (146, 2.7) 4 (282, 1.4) 0.1929
Smoking 44 (135, 32.6) 97 (261, 37.2) 0.1813
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Table 14. The comparison for the proportions of two arrival time groups which one is less than three hours and another one is over three hours for patients with different risk factors.
Variable, n (Total, %)
The arrival time
P-value
≦3 hours ＞3 hours
Hypertension 163 (195, 83.6) 203 (230, 88.3) 0.0846
Dyslipidemia 68 (178, 38.2) 105 (216, 48.6) 0.0184
Diabetes Mellitus 66 (195, 33.9) 105 (224, 46.9) 0.0031
Previous CVA 63 (196, 32.1) 74 (230, 32.2) 0.4973
Previous TIA 5 (196, 2.6) 3 (232, 1.3) 0.1755
Smoking 61 (179, 34.1) 80 (217, 36.9) 0.2817
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Table 15. The comparison for the association of the arrival time within two hours and patients with deterioration.
Table 16. The comparison for the association of the arrival time within two hours and patients with different deteriorations.
* By using the Fisher exact test.
38
Table 18. The comparison for the association of the arrival time with three hours and patients with different deteriorations.
* By using the Fisher exact test.
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Table 19. The comparison for the proportions of two arrival time groups which one is less than two hours and another one is over two hours for patients with deteriorations.
Variable, n (%)
The arrival time
P-value
≦2 hours (n=148) ＞2 hours (n=282)
Deterioration 24 (16.2) 46 (16.3) 0.4898
Table 20. The comparison for the proportions of two arrival time groups which one is less than two hours and another one is over two hours for patients with different deteriorations.
Variable, n (%)
The arrival time
P-value
≦2 hours (n=148) ＞2 hours (n=282)
Stroke-in-evolution 18 (12.2) 41 (14.5) 0.2429
Herniation 1 (0.7) 0 (0.0) 0.1578
Hemorrhagic Infarct 5 (3.4) 4 (1.4) 0.1165
Other 2 (1.4) 1 (0.4) 0.1626
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Table 21. The comparison for the proportions of two arrival time groups which one is less than three hours and another one is over three hours for patients with deterioration.
Variable, n (%)
The arrival time
P-value
≦3 hours (n=198) ＞3 hours (n=232)
Deterioration 31 (15.7) 39 (16.8) 0.3730
Table 22. The comparison for the proportions of two arrival time groups which one is less than three hours and another one is over three hours for patients with different deteriorations.
Variable, n (%)
The arrival time
P-value
≦3 hours (n=198) ＞3 hours (n=232)
Stroke-in-evolution 24 (12.1) 35 (15.1) 0.1846
Herniation 1 (0.5) 0 (0.0) 0.1580
Hemorrhagic Infarct 5 (3.0) 3 (1.3) 0.1116
Other 2 (1.0) 1 (0.4) 0.2429
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Table 23. The comparison for the means of Barthel index of two arrival time groups which one is less than two hours and another one is over two hours for the difference of two stages.
Stage, mean
The arrival time
P-value of testing the equality of two means
≦ 2 hours ＞2 hours
Stage 1 to Stage 2 3.089 4.269 0.3412
Stage 1 to Stage 3 3.171 3.580 0.7603
Stage 1 to Stage 4 1.667 1.356 0.7217
Stage 1 to Stage 5 -4.000 -3.223 0.7408
Stage 2 to Stage 3 6.322 8.069 0.3476
Stage 3 to Stage 4 8.898 9.323 0.8234
Stage 4 to Stage 5 5.120 6.524 0.6751
*Stage 1: Patient discharged from the hospital.
Stage 2: Patient with stroke after one month.
Stage 3: Patient with stroke after three months.
Stage 4: Patient with stroke after six months.
Stage 5: Patient with stroke after one year.
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Table 24. The comparison for the means of Barthel index of two arrival time groups which one is less than three hours and another one is over three hours for the difference of two stages.
Stage, mean
The arrival time
P-value of testing the equality of two means
≦ 3 hours ＞3 hours
Stage 1 to Stage 2 3.423 4.255 0.4722
Stage 1 to Stage 3 3.533 3.374 0.8959
Stage 1 to Stage 4 1.242 1.641 0.6334
Stage 1 to Stage 5 -4.646 -2.536 0.3028
Stage 2 to Stage 3 7.012 7.968 0.6128
Stage 3 to Stage 4 8.797 9.482 0.7043
Stage 4 to Stage 5 4.000 7.701 0.2213
*Stage 1: Patient discharged from the hospital.
Stage 2: Patient with stroke after one month.
Stage 3: Patient with stroke after three months.
Stage 4: Patient with stroke after six months.
Stage 5: Patient with stroke after one year.
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Table 25. The comparison for the means of mRS of two arrival time groups which one is less than two hours and another one is over two hours for the difference of two stages.
Stage, mean
The arrival time
P-value of testing the equality of two means
≦ 2 hours ＞2 hours
Stage 1 to Stage 2 -0.146 -0.261 0.0694
Stage 1 to Stage 3 -0.154 -0.244 0.1432
Stage 1 to Stage 4 -0.067 -0.085 0.7448
Stage 1 to Stage 5 0.047 0.078 0.7928
Stage 2 to Stage 3 -0.306 -0.500 0.0245
Stage 3 to Stage 4 -0.407 -0.575 0.0795
Stage 4 to Stage 5 -0.361 -0.524 0.3060
*Stage 1: Patient discharged from the hospital.
Stage 2: Patient with stroke after one month.
Stage 3: Patient with stroke after three months.
Stage 4: Patient with stroke after six months.
Stage 5: Patient with stroke after one year.
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Table 26. The comparison for the means of mRS of two arrival time groups which one is less than three hours and another one is over three hours for the difference of two stages.
Stage, mean
The arrival time
P-value of testing the equality of two means
≦ 3 hours ＞3 hours
Stage 1 to Stage 2 -0.179 -0.260 0.1591
Stage 1 to Stage 3 -0.168 -0.252 0.1500
Stage 1 to Stage 4 -0.075 -0.082 0.8867
Stage 1 to Stage 5 0.088 0.051 0.7203
Stage 2 to Stage 3 -0.348 -0.507 0.0471
Stage 3 to Stage 4 -0.449 -0.575 0.1823
Stage 4 to Stage 5 -0.373 -0.547 0.2426
*Stage 1: Patient discharged from the hospital.
Stage 2: Patient with stroke after one month.
Stage 3: Patient with stroke after three months.
Stage 4: Patient with stroke after six months.
Stage 5: Patient with stroke after one year.
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Figure 1. The means of Barthel index of two arrival time groups which one is less than two hours and another one is over two hours for the difference of two stages.
Figure 2. The means of Barthel index of two arrival time groups which one is less than three hours and another one is over three hours for the difference of two stages.
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Figure 3. The means of mRS of two arrival time groups which one is less than two hours and another one is over two hours for the difference of two stages.
Figure 4. The means of mRS of two arrival time groups which one is less than three hours and another one is over three hours for the difference of two stages.