Factors Predicting Hospital Arrival among Acute Stroke Patients: A Systematic Review

Stroke disease causes disability and death worldwide. Early hospital arrival was declared to be significant in reducing complications and disabilities from a stroke. Currently, there is a limited study related to factors influencing early or delayed hospital arrival. Therefore, this study aimed to identify early and delayed hospital arrival predictors in acute stroke patients. A systematic review was sought from many databases, including Scopus, PubMed, and Google Scholar, full-text articles using the statistical regression analysis, published in English, studied in all subtypes of stroke patients and published during 2011-2021. The studies were excluded if they used a small sample size and were not original articles. Two independent reviewers assessed the risk of bias. Two independent researchers verified the quality of selected papers using the STROBE guideline (Strengthening the Reporting of Observation Studies in Epidemiology). Ten studies were recruited for this review. Factors predicting early hospital arrival were higher household income, higher educational level, medical history of atrial fibrillation, coronary artery disease, previous ischemic stroke/transient ischemic attack, unconsciousness at present, presence with hemiplegia, seizure, high national institutes of health stroke scale (NIHSS) score, hemorrhagic stroke, and daytime onset, use of emergency medical service (EMS), early presence at an emergency department, stroke recognition, distance from the hospital ≤ 15 kilometers, absence of traffic jams, and symptoms development at home. Factors predicting delayed hospital arrival were older age, female gender, financial problem, and distance from the hospital >20 kilometers. Other predictors were worsened symptoms at an emergency department, consciousness at present, low NIHSS score, unknown or awakening or nighttime onset, self-presence at an emergency department, referred, stroke unaware, stroke treatment ignorance, and symptoms development at home. Findings suggest the educational intervention to raise stroke public knowledge and promote early care-seeking. Increase the use of EMS is an essential method to speed hospital arrival