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Trends in acute stroke presentations to an emergency department: implications for specific communities in accessing acute stroke care services
  1. Sonu Bhaskar1,2,3,4,
  2. Peter Thomas1,2,
  3. Qi Cheng1,2,
  4. Nik Clement5,
  5. Alan McDougall1,2,4,
  6. Suzanne Hodgkinson1,2,4,
  7. Dennis Cordato1,2,3,4
  1. 1 Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, New South Wales, Australia
  2. 2 Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
  3. 3 South West Sydney Clinical School, School of Medicine, Western Sydney University, Liverpool, NSW, Australia
  4. 4 The University of New South Wales, Sydney, NSW, Australia
  5. 5 Business Intelligence Unit, Liverpool Hospital and South West Sydney Local Health District (SWSLHD), Liverpool, New South Wales, Australia
  1. Correspondence to Dr Sonu Bhaskar, Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; Sonu.Bhaskar{at}


Background and purpose South Western Sydney comprises of a culturally and linguistically diverse (CALD) and lower socioeconomic status population group within the state of New South Wales. Geographic location and sociodemographic factors play important roles in access to healthcare and may be crucial in the success of time-critical acute stroke intervention. The aim of this study was to examine the trends in the delayed presentation to emergency department (ED) and identify factors associated with prehospital delay for an acute stroke/transient ischaemic attack (TIA) at a comprehensive stroke centre.

Methods Patient health-related data were extracted for stroke/TIA discharges for the period 2009–2017. Electronic medical record data were used to determine sociodemographic characteristics and prehospital factors, and their associations with delayed presentation≥4.5 hours from stroke onset were studied.

Results During the 9-year period, population-adjusted stroke/TIA discharge rates increased from 540 to 676 per 100 000. A significant reduction in the proportion of patients presenting to ED<4.5 hours (56% in 2009 versus 46% in 2017, p<0.001) was observed. Younger patients aged 55–64 and 65–74 years, those belonging to Polynesia, South Asia and Mainland Southeast Asia, and those not using state ambulance as the mode of arrival to the hospital were at increased risk of prehospital delay.

Conclusions Comprehensive reappraisal of educational programmes for early stroke recognition is required in our region due to delayed ED presentations of younger and specific CALD communities of stroke/TIA patients.

  • stroke
  • delayed presentation
  • culturally and linguistically diverse (CALD) population
  • health systems
  • health promotion
  • health policy
  • emergency department
  • health equity
  • healthcare access

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  • Presented at Stroke 2018, the Stroke Society of Australasia (SSA) 28th Annual Scientific Meeting; 7-10 August, 2018; Sydney, Australia

  • Contributors SB contributed to the planning, ethics submission, data analysis and writing of the manuscript. SB wrote the first draft of the paper. PT contributed to the planning, data management, data analysis and revision of the manuscript. DC, AM and SH contributed to the planning and revision of the manuscript. PT, QC and NC contributed to the ethics submission and procurement/analysis of eMR data.

  • Funding Seed funding from the UNSW Medicine, Neuroscience, Mental Health and Addictions Theme and SPHERE Collaborative Research 2018 Round is acknowledged.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the South West Sydney Human Research Ethics Committee (LNR/18/LPOOL/94).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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