Supplementary Material for: Treatment Delays and Chance of Reperfusion Therapy in Patients with Acute Stroke: A Danish Nationwide Study

<b><i>Introduction:</i></b> We aimed to determine the treatment delay for ischemic stroke patients in Denmark. <b><i>Methods:</i></b> A nationwide register-based study on acute ischemic stroke patients admitted through emergency medical services. Treatment delay comprised patient, prehospital, and in-hospital delay. Analyses were stratified according to length of prehospital delay (&lt;3 vs. ≥3 h). <b><i>Results:</i></b> A total of 5,356 ischemic stroke episodes were included. The median onset-to-door time was 187 min, and 2,405 (43%) arrived at the stroke unit within 3 h. Overall, the median patient delay was 115 min. For early arrival (<i>n</i> = 2,280), patient delay was 27 min compared to 437 min for late arrivals (<i>n</i> = 2,448). Median prehospital delay varied by 9 min between early- and late-arriving patients. Approximately 48% of the early-arriving patients compared to 9% of the late-arriving patients received i.v. thrombolysis. For thrombectomy, the numbers were 10% and 3%, respectively. This corresponded to an unadjusted relative risk (RR) of 0.18 (95% CI: 0.16–0.21) and adjusted (age, sex, cohabitation status, and stroke severity) RR of 0.20 (95% CI: 0.18–0.23) for i.v. thrombolysis when comparing patients arriving later than 3 h with patients arriving earlier. For thrombectomy, the unadjusted and adjusted RRs were 0.30 (95% CI: 0.23–0.39) and 0.40 (95% CI: 0.31–0.52), respectively. <b><i>Conclusions:</i></b> Patient delay remains the most important barrier for use of reperfusion therapy among acute ischemic stroke patients calling 1-1-2, whereas system delay seems independent of patient delay.

**引言：** 本研究旨在明确丹麦缺血性脑卒中患者的治疗延误情况。
**研究方法：** 本研究为基于全国登记系统的队列研究，对象为通过急救医疗服务收治的急性缺血性脑卒中患者。治疗延误涵盖患者延误、院前延误及院内延误三个维度。研究按照院前延误时长（<3小时与≥3小时）进行分层分析。
**研究结果：** 本研究共纳入5356例缺血性脑卒中发作病例。患者发病至抵达医院的中位时长为187分钟，其中2405例（43%）在发病后3小时内抵达卒中单元。整体而言，患者延误的中位时长为115分钟。早抵达组（n=2280）的患者延误中位时长为27分钟，晚抵达组（n=2448）则为437分钟。早抵达与晚抵达患者的院前延误中位时长相差9分钟。约48%的早抵达患者接受了静脉溶栓（intravenous thrombolysis）治疗，而晚抵达患者的这一比例仅为9%；血管内取栓（thrombectomy）的对应比例则分别为10%与3%。以晚抵达（发病后3小时以上抵达）患者与早抵达患者进行对比，静脉溶栓治疗的未校正相对风险（relative risk, RR）为0.18（95%置信区间：0.16~0.21），校正年龄、性别、同居状态及卒中严重程度后的相对风险为0.20（95%置信区间：0.18~0.23）。血管内取栓治疗的未校正与校正后相对风险分别为0.30（95%置信区间：0.23~0.39）与0.40（95%置信区间：0.31~0.52）。
**结论：** 对于拨打急救电话1-1-2的急性缺血性脑卒中患者而言，患者延误仍是影响其接受再灌注治疗（reperfusion therapy）的最主要障碍，而系统延误则与患者延误无关。