Pre Hospitalization Delays in severe health conditions

In India, hospitalisation rates range rose from 26% to 69% because many people who experience a stroke do not access hospital services on time.

Pre Hospitalization Delays in severe health conditions
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Stroke is the fourth leading cause of death and the fifth leading cause of disability. Stroke incidences in India were estimated to be between 105 and 152 people per 100,000 population, or over 1.5 million cases per year. However, in India, hospitalisation rates range rose from 26% to 69% because many people who experience a stroke do not access hospital services on time. There are very few ambulance services in rural areas to carry patients to facilities. In urban India, most of them cause delays due to a lack of ambulance services. The ideal window time of the patient's arrival at the hospital is within 4 hours from the stroke onset. The time of onset of stroke is defined as when the patient is noted with first symptom suggestive of stroke. As evidenced by a study, only 30% population reached the hospital before 4 hours. Of every 10,000 stroke victims, 50 die.

Symptoms of Stroke

Ø  Numbness or weakness,

Ø Loss of consciousness

Ø  Decreased vision in one or both eyes

Ø  Speaking and understanding difficulties,

Ø  Loss of balance or coordination

Ø  Confusion or loss of memory

Ø  Paralysis of any body area, including face

Ø  Severe headache and neck pain with no known cause

Ø  Nausea and vomiting

The delay may be caused by several factors, including lack of knowledge and awareness of stroke symptoms, travel distance between home and hospital, lack of ambulance staff and transportation, and the availability of non-hospital based therapies that people may consider sufficient after stroke. The patients who came within the window period are more aware of stroke symptoms.

Therefore, as recommended in various studies, prior knowledge about stroke symptoms or stroke being an emergency is the most important determinant of early arrival to the hospital. Thrombolysis therapy, considered the best treatment, could save many lives. Despite this, India has a poor response to pre-hospitalization delays. Among the population, 29 per cent know about stroke warning signs, and just 17 per cent were aware of the time window of thrombolysis therapy. Thrombolysis has a limited therapeutic time window of 3⋅0 hrs to 4.5 hrs after the onset of stroke symptoms. It is an emergency treatment to dissolve dangerous clots in blood vessels, improve blood flow, and prevent damage to tissues and organs. Thrombolysis may involve the injection of clot-busting drugs that deliver drugs directly to the site of the blockage.

Thrombolysis therapy has good clinical efficacy; it can be a good option considering its lower cost and ease of administration. However, the proportion of patients receiving thrombolysis therapy in acute stroke is pathetically low in India. There has been research showing that for every 15-minute delay between arrival at the emergency room and thrombolysis, mortality drops by 5 percent. Stroke causes 1246 Disability Adjusted Life Years per 1, 00,000 population. A 15-minute early treatment can provide an average of 1 month of additional disability-free life to the patient. Hence, we need a robust public education campaign to address the factors responsible.