Pre-Hospital Delay and Associated Factors of Ischemic Stroke in Northern Mediterranean Countries: A Literature Review

Ahmed Kharbach 1 * , Majdouline Obtel 1 2, Mohamed Amine Baba 3 4, Laila Lahlou 4, Rachid Razin 1 2
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1 Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, MOROCCO
2 Laboratory of Social Medicine (Public Health, Hygiene and Preventive Medicine), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, MOROCCO
3 Laboratory of Health Sciences, National School Applied Sciences, Ibn Zohr University, Agadir, MOROCCO
4 Faculty of Medicine and Pharmacy of Agadir, University Ibn Zohr, Agadir, MOROCCO
* Corresponding Author
EUR J BASIC MED SCI, Volume 9, Issue 1, pp. 5-16.
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The emergence of new therapeutic protocols for reperfusion requires the respect of a therapeutic window which consists of an optimal admission time of 4.5 hours, and which should not exceed 6 hours according to the latest clinical trials. The objective of this narrative review of the literature is to identify the time of admission of patients arriving at emergency departments for ischemic stroke after the onset of symptoms, as well as the factors that influence it in four European countries of the Northern Mediterranean (Spain, France, Italy, and Turkey).
Twenty-two studies published between 2004 and 2018 were included. The mean pre-hospital delay ranged from 7.65 hours to 22.5 hours. The median prehospital delay ranged from 1.54 to 6.08 hours. The proportion of patients consulting after the first 3 hours ranged from 31.6 to 96.29%. Almost half of the studies (45%) associated the transport used with early admission delay. More than a third of the studies (36%) revealed an association of this delay with the destination of the first call after the signs related to the stroke was noticed. Whereas, 32% of the studies showed that vigilance (consciousness) disorders were the symptoms most related to early admission due to their severity. In addition, advanced age was implicated in 27% of the studies as a determinant contributing to a reduction of the time to arrival of patients. Besides, the lack of awareness and underestimation of symptoms was reported in 13% of the studies, constituting the main barrier affecting negatively early admission.
These findings show that the optimal therapeutic window recommended is not always respected even if in developed countries, and that ignorance about the symptoms evocative of ischemic stroke still remains in Northern Mediterranean countries. This implies that measures ought to be implemented in order to improve care in the best possible way, focusing mainly on educating and raising the awareness of the population about the signs of this disabling disease and the actions to be taken.


Kharbach A, Obtel M, Baba MA, Lahlou L, Razin R. Pre-Hospital Delay and Associated Factors of Ischemic Stroke in Northern Mediterranean Countries: A Literature Review. Eur J Basic Med Sci. 2019;9(1):5-16.


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