Analysis of Time to the Hospital and Ambulance Use Following a Stroke Community Education Intervention in China

Key Points

Question

Is Stroke 1-2-0, a community education campaign on rapid assessment of an individual potentially having a stroke, associated with time to arrival at the hospital and the use of an ambulance?

Findings

This population-based cross-sectional study evaluated 2857 Chinese individuals with ischemic stroke. Following implementation of the Stroke 1-2-0 program, the delay in hospital arrival time was significantly decreased and use of an ambulance was significantly increased.

Meaning

The findings of this study suggest a multifaceted campaign increasing the recognition of stroke and appropriate action may be useful in achieving timely hospital arrival.

Abstract

Importance

Prehospital delay (time from symptom onset of stroke to the door of a hospital) in patients with stroke is long in China. With the goal of improving public awareness and knowledge of stroke recognition, Stroke 1-2-0 was developed in China as an education program to prompt rapid response to the onset of stroke based on clinical practice in China, and examination of its outcomes is needed.

Objective

To investigate the association of the Stroke 1-2-0 educational campaign with prehospital delay for patients with ischemic stroke.

Design, Setting, and Participants

In a population-based cross-sectional study, all patients with ischemic stroke events were admitted to the Minhang Hospital, which is the only tertiary care hospital with a stroke center that provides acute stroke care in Xinzhuang county, Shanghai, China. The study period was from January 1, 2016, to December 31, 2019, and data analysis was performed from January 1 to July 31, 2021.

Exposures

A multifaceted Stroke 1-2-0 educational campaign comprising slides, videos, brochures, and posters distributed in the community.

Main Outcomes and Measures

Proportion of patients with hospital arrival within 3 hours and use of an ambulance to seek medical care, as well as the odds of seeking medical attention within 3 hours after the stroke before vs after initiation of the multifaceted educational campaign.

Results

A total of 2857 patients (1774 men [62.1%]; mean [SD] age, 69.83 [12.66] years) with stroke were identified, including 503 in the precampaign period and 2354 in the postcampaign period. Following the multifaceted campaign, the median (IQR) prehospital delay time decreased from 18.72 (7.44-27.84) hours to 6.00 (2.00-16.35) hours ( P < .001). After the implementation of the Stroke 1-2-0 campaign, the proportion of patients with hospital arrival time within 3 hours increased from 5.8% to 33.4% ( P < .001) and use of an ambulance increased from 3.2% to 30.6% ( P < .001). In an interrupted time series analysis, the initiation of the Stroke 1-2-0 campaign was associated with significantly increased odds of arriving at the hospital within 3 hours (odds ratio, 8.01; 95% CI, 7.17-8.95; P < .001) and use of an ambulance (odds ratio, 9.41; 95% CI, 8.24-10.74; P < .001).

Conclusions and Relevance

The persistent multifaceted campaign using the Stroke 1-2-0 program was associated with reduced prehospital delay and improved timely arrival rate and ambulance arrival rate for patients with stroke. These findings suggest that Stroke 1-2-0 can be adopted in other regions of China to possibly improve health outcomes and reduce clinical burdens for all patients with stroke.

Abstract

This cross-sectional study examines hospital arrival time and use of ambulances following implementation of a community education program to increase recognition of stroke.