Email this article 
Hide
Show all
Original Research
A retrospective analysis of time delays in patients presenting with stroke to an academic emergency department
Submitted: 12 February 2018 | Published: 21 June 2018
About the author(s)
Diteboho Khalema, Department of Radiology, University of the Witwatersrand, South AfricaLara N. Goldstein, Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
Susan Lucas, Department of Radiology, University of the Witwatersrand, South Africa
Abstract
Background: Stroke presents commonly to the emergency department (ED), and is a common cause of morbidity and mortality in South Africa. Early ED presentation and early neuroimaging are required in order for thrombolysis to be a potential therapeutic modality.
Objectives: To determine the time to ED presentation, time to computed tomography (CT) scan and the potential influencing factors for patients with stroke.
Methods: A retrospective record review of all patients who presented with clinical features of stroke to a tertiary academic ED in Johannesburg, South Africa, from 01 January to 31 December 2014.
Results: Data from 232 eligible stroke patients were analysed. The median time to presentation to the ED was 33 h with the majority of patients (81.3%) presenting after the 4.5 h window for thrombolysis. The median time to CT was 8 h. Only 3.9% of patients had a CT scan within one hour of arrival. Patients with loss of consciousness were associated with earlier hospital presentation (p = 0.001). None of the patients were thrombolysed.
Conclusion: Patients with stroke commonly present late to hospital. If we are to make a difference in this group of vulnerable patients, further education and training needs to be emphasised regarding ‘time is brain’. Communication and commitment is also required by the emergency medical services, ED and radiology staff in order to prioritise stroke patients and to reduce delays.
Keywords
Metrics
Total abstract views: 5338Total article views: 7515
Crossref Citations
1. Functioning Problems Associated with Health Conditions with Greatest Disease Burden in South Africa: A Scoping Review
Maria Y. Charumbira, Karina Berner, Quinette A. Louw
International Journal of Environmental Research and Public Health vol: 19 issue: 23 first page: 15636 year: 2022
doi: 10.3390/ijerph192315636
2. Current management of acute ischemic stroke in Africa: A review of the literature
Olivier Uwishema, Christin Berjaoui, Inês F. Silva Correia, Heeba Anis, Ece Karabulut, Dina Essayli, Melissa Mhanna, Adekunbi Oluyemisi
European Journal of Neurology vol: 29 issue: 11 first page: 3460 year: 2022
doi: 10.1111/ene.15495
3. Access to acute care resources in various income settings to treat new-onset stroke: A survey of acute care providers
Ramadhan Chunga, Stevan R. Bruijns, Clint Hendrikse
African Journal of Emergency Medicine vol: 9 issue: 2 first page: 77 year: 2019
doi: 10.1016/j.afjem.2019.01.002
4. Predicting Mortality in Trauma Research: Evaluating the Performance of Trauma Scoring Tools in a South African Population
Christopher E Collora, Mengli Xiao, Bailey Fosdick, Hendrick J Lategan, Julia Finn, Steven G Schauer, Julia Dixon, Smitha Bhaumik, Willem Stassen, Shaheem de Vries, Craig Wylie, Nee-Kofi Mould-Millman
Cureus year: 2024
doi: 10.7759/cureus.71225
5. Time delays in emergency stroke care in a low-resource referral hospital in Ghana
Hussein A Yakubu, Richmond O Marfo, Jonathan Boakye-Yiadom, Freda M Aidoo, Fred S Sarfo, Rockefeller A Oteng
African Journal of Emergency Medicine vol: 15 issue: 3 first page: 100882 year: 2025
doi: 10.1016/j.afjem.2025.05.006
6. Impact of short-term (24 h) blood pressure variability on 30-days clinical outcomes of acute strokes at two tertiary hospitals in Dar-es-Salaam
Ayubu Eliesikia Mashambo, Mandela Charles Makakala, Philip Babatunde Adebayo
Frontiers in Stroke vol: 4 year: 2025
doi: 10.3389/fstro.2025.1700321
7. Acute stroke in the emergency department: A chart review at KwaZulu-Natal hospital
Steve G. Feris, Bavani Naicker
South African Family Practice vol: 62 issue: 1 year: 2020
doi: 10.4102/safp.v62i1.5126
8. Missed golden hours of stroke patients at Zweditu Memorial Hospital in Addis Ababa, Ethiopia
Robel Sintayehu, Tsion Tinsae, Merahi Kefyalew
BMC Neurology vol: 25 issue: 1 year: 2025
doi: 10.1186/s12883-025-04209-1
9. Access to acute stroke care: A retrospective descriptive analysis of stroke patients’ journey to a district hospital
Ryan Mark O'Meara, Ushira Ganas, Clint Hendrikse
African Journal of Emergency Medicine vol: 12 issue: 4 first page: 366 year: 2022
doi: 10.1016/j.afjem.2022.07.010
10. Barriers to thrombolysis in acute ischaemic stroke: an epidemiological review from a tertiary hospital in the Eastern Cape, South Africa
Roswyn Pasio, Roshen Maharaj, Kevin Pasio
African Journal of Emergency Medicine vol: 16 issue: 1 first page: 100945 year: 2026
doi: 10.1016/j.afjem.2026.100945
11. Efficacy and safety of CDP-choline, cerebrolysin, MLC601, and edaravone in recovery of patients with acute ischemic strokes: a meta-analysis
Shafiq Dexter B. Abou Zaki, Johnny K. Lokin
Exploration of Neuroprotective Therapy first page: 398 year: 2023
doi: 10.37349/ent.2023.00057
12. A systematic review on the analysis of study design, statistical methods and statistical software tools used in South African health science research
Murugan Kaleeswari, Gurusamy Manikandan, David Katerere, Palanisamy Muthukumar
Discover Data vol: 3 issue: 1 year: 2025
doi: 10.1007/s44248-025-00083-x
13. Factors facilitating pre-hospital delays in stroke patients’ presentation to hospital by their caretakers in Uganda and suggested interventions
Salvatore Ssemmanda
BMC Neurology vol: 25 issue: 1 year: 2025
doi: 10.1186/s12883-025-04360-9