Understanding delays in acute stroke care: a systematic review of reviews

Yacine Lachkhem 1 Stephane Rican 2 Etienne Minvielle 1
1 EA MOS - EA Management des Organisations de Santé
PRES Sorbonne Paris Cité, EHESP - École des Hautes Études en Santé Publique [EHESP] : EA 7348 MOS
Abstract : Abstract Background: Stroke is the leading cause of adult long-term disability in Western countries. Intravenous thrombolytic therapy with recombinant tissue plasminogen activator is safe and effective within the first 4.5 h after the onset of stroke. Various factors delaying acute stroke care have been identified in the literature. This review aimed to provide an overview of factors delaying acute stroke care and attempted to show how they interact in a synthetic framework. Methods: We conducted a systematic review of literature reviews published in Medline and DORIS until 2016 on factors influencing acute stroke pathway timeframe. Results: We analyzed 31 reviews that cover all factors of delays from stroke onset to treatment. We identified 27 factors that had a significant impact on acute stroke care and can be categorized into four distinct categories: patient-related factors, training, resources and lack of coordination. We also reported associations between factors observed in both between categories (mainly between patients and organizational/logistical factors) and within categories. Conclusion: This review provides a wide overview of factors influencing acute stroke pathway. Since it was observed that the identified factors were interrelated, they needed to be analyzed in a systematic way. We hence created a synthetic framework that combines several categories of factors while assuming that factor weight varies from a study context to another. Better knowledge on underlying mechanisms between factors would provide crucial improvement of the interventions aiming at reducing delays in both pre-hospital and inhospital stages. For future research, we recommend adopting a systemic perspective on factors influencing acute stroke pathway.
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European Journal of Public Health, Oxford University Press (OUP): Policy B - Oxford Open Option D, 2018, 28 (3), pp.426 - 433. 〈10.1093/eurpub/cky066〉
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https://hal.archives-ouvertes.fr/hal-01802319
Contributeur : Stephane Rican <>
Soumis le : mardi 29 mai 2018 - 11:10:06
Dernière modification le : mercredi 4 juillet 2018 - 23:14:06

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Yacine Lachkhem, Stephane Rican, Etienne Minvielle. Understanding delays in acute stroke care: a systematic review of reviews. European Journal of Public Health, Oxford University Press (OUP): Policy B - Oxford Open Option D, 2018, 28 (3), pp.426 - 433. 〈10.1093/eurpub/cky066〉. 〈hal-01802319〉

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