Impact of a prolonged nationwide residents’ strike on acute ischemic stroke care in a metropolitan city

Impact of a prolonged nationwide residents’ strike on acute ischemic stroke care in a metropolitan city | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of a prolonged nationwide residents’ strike on acute ischemic stroke care in a metropolitan city Sang-Hun Lee, Hyun Wook Ryoo, Tae-Kwon Kim, Jae Yun Ahn, Sungbae Moon, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7359511/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Acute ischemic stroke (AIS) requires timely management in both prehospital and in-hospital phases to optimize outcomes. In 2024, South Korea experienced a prolonged nationwide residents’ strike that disrupted the healthcare system, potentially affecting AIS management. This study evaluated the impact of the residents’ strike on time-to-management outcomes in patients with AIS. Methods We performed a retrospective multicenter study of AIS patients who presented within 24 hours of symptom onset to six major hospitals in Daegu, South Korea, between March and December in both 2023 and 2024. Clinical characteristics and management times were compared according to strike status and further analyzed by dividing patients into early and late strike phases. Results A total of 2,059 AIS patients were included. During the late phase of the residents’ strike, patients transported by 119 public emergency medical service dispatches experienced delayed hospital arrival (83 minutes vs. 98 minutes, p = 0.003). Logistic regression analysis further demonstrated that the late phase of the strike was associated with significant delays in intravenous thrombolysis initiation (adjusted odds ratio, 0.48; 95% confidence interval, 0.25–0.95). Conclusion The prolonged residents’ strike in South Korea resulted in delays in AIS management, particularly during the late phase, impacting both prehospital transport by 119 public emergency medical service dispatches and timely intravenous thrombolysis administration. Stroke Emergency medical services Strike Employee Figures Figure 1 Figure 2 Introduction Acute ischemic stroke (AIS) is a time-sensitive condition, and rapid management in both prehospital and in-hospital phases is essential for optimal clinical outcomes [ 1 ]. In the prehospital phase, prompt recognition of AIS onset and expeditious transfer to the hospital, including pre-notification by professional emergency medical services (EMSs), are critical [ 2 , 3 ]. In the in-hospital phase, rapid brain imaging, such as computed tomography (CT), and Prompt initiation of intravenous thrombolysis (IVT) and endovascular treatment (EVT) is essential within the appropriate therapeutic window [ 4 ]. Management of AIS involves sequential, interdependent steps, and prompt intervention at each stage is necessary to provide optimal care [ 5 ]. These coordinated efforts have improved outcomes for patients with AIS [ 6 ]. In February 2024, South Korean resident physicians commenced a walkout in response to the government’s proposed healthcare reform [ 7 ]. Consequently, major hospitals faced physician shortages, leading to delays and cancellations of outpatient services and procedures, and restrictions in accepting and treating patients in emergency departments (EDs) [ 7 ]. Due to these limitations, patients with acute AIS no longer benefited from previously established advanced treatment systems. It is presumed that the residents’ strike caused delays in both prehospital and in-hospital treatment for AIS patients; however, research on this issue is lacking. Therefore, we analyzed the clinical outcomes of AIS patients during the residents’ strike in Daegu, South Korea. Methods Study overview and enrollment We conducted a retrospective before-and-after comparative study in Daegu, the fourth-largest metropolitan city in South Korea, encompassing the periods from March 1 to December 31 in 2023 and 2024. The study encompassed all 119 ambulances operating across approximately 50 fire safety centers. All major hospitals in Daegu participated, including two regional emergency medical centers and four local emergency medical centers. The study population comprised adults (≥ 18 years) who visited the ED with AIS, with symptom onset within 24 hours of last known well. Patients eligible for reperfusion therapy who declined treatment were excluded. Cases were also excluded if relevant data were unavailable or if medical records could not be verified. To compare periods before and after the residents’ strike, AIS patients from 2023 and 2024 were analyzed. To evaluate the early and late phases of the strike, the year 2024 was divided into two subgroups: March to May (first three months) and June to December. Definition and measurement Patients were classified by mode of hospital arrival. The public EMS group consisted of patients who were taken directly from the scene by the national 119 ambulance service, which is operated by the fire department in South Korea. The private EMS group comprised patients initially suspected or diagnosed at another hospital and subsequently transferred by private ambulance. The general passenger car group consisted of patients who arrived using private vehicles without ambulance services. Neurological evaluation was conducted with the National Institutes of Health Stroke Scale (NIHSS), which was recorded at both admission and discharge [ 8 ]. Stroke severity was classified into four categories based on NIHSS scores: mild (one to four), moderate (five to fifteen), moderately severe (sixteen to twenty), and severe (twenty‑one to forty‑two) [ 2 ]. Symptom onset time was defined as the first abnormal time, and onset-to-door time was measured from first the abnormal time. Door time referred to the exact time at which the patient completed registration at the ED following arrival. Key time metrics for diagnosis and treatment were documented upon hospital arrival, encompassing the intervals from door to CT imaging, IVT, and EVT. CT time was recorded as the timestamp when the first scan image was generated. IVT time was recorded at the moment tissue plasminogen activator was administered, and EVT time corresponded to the start of arterial puncture. Data collection Patient data with ICD-10-CM diagnostic codes I60–I64 (the U.S. clinical modification of the 10th revision of the International Classification of Diseases) were extracted from the electronic medical records (EMRs) of the six participating hospitals. Codes were assigned by on-duty neurologists based on final diagnoses supported by examination and imaging. Data for the study cohort were obtained from hospital EMRs and 119 EMS run sheets from Daegu. We collected data on age, sex, medical history, mode of arrival, symptom onset time, length of hospital stay, in-hospital mortality, mental status, neurological assessments, and treatments from EMRs. For patients transported by public EMS, response time and scene-to-door time were extracted from EMS run sheets. Statistical analysis For continuous variables, data were expressed as medians with interquartile ranges, and group comparisons were performed using Student’s t‑test or, when appropriate for non‑normal distributions, the Mann–Whitney U test. For categorical variables, data were summarized as frequencies with corresponding percentages, and intergroup comparisons employed the chi‑square test or Fisher’s exact test when indicated. To assess the association between baseline characteristics and the impact of the residents’ strike on management timeliness—such as brain CT, IVT, and EVT—univariate logistic regression was initially performed. In accordance with American Heart Association/American Stroke Association guidelines, the times from door to CT, IVT, and EVT were dichotomized using thresholds of 20, 60, and 90 minutes, respectively [ 9 ]. Multivariable logistic regression was applied to determine factors influencing the timely completion of CT and reperfusion treatments, with covariates including age, sex, comorbidities, initial NIHSS score, transport modality, and the presence and timing of the resident strike. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to present the results. Strike timing was categorized as early or late, with the pre-strike period as the reference. Statistical analyses were carried out with SPSS Statistics for Windows, version 29.0. Results During the study period, 2,059 AIS patients within 24 hours of last known normal presented to six major hospitals in Daegu city. Among these, 1,170 patients (56.8%) presented in 2023, before the residents’ strike, and 889 patients (43.2%) presented in 2024, after the strike began (Fig. 1 ). In the After period, the time from on-site arrival to hospital transport increased following the initial three months ( p < 0.001). Based on this trend, the strike period was divided into early and late phases (Fig. 2 ). In the first three months of the strike, 301 AIS patients (14.6%) presented, while 588 patients (28.6%) presented in the later phase (Fig. 1 ). The median age of the study population was 73 years, and 1,213 patients (58.9%) were male. Anticoagulant use was more common during the residents’ strike ( p < 0.001), especially in the later phase ( p = 0.001). Other comorbidities did not differ significantly between the pre-strike and post-strike periods. During the strike, a higher proportion of patients arrived via public EMS, while the use of private EMS and general passenger vehicles declined ( p = 0.023). Regarding treatment, conservative management increased during the strike, while IVT alone and combined IVT with EVT decreased ( p = 0.008). Comparing the early and late phases, conservative management further increased in the late phase. In contrast, the use of IVT alone and combined IVT with EVT rose, whereas EVT alone declined ( p = 0.005). The proportion of patients receiving IVT increased from 10.3% in the early phase to 14.9% in the late phase, while the EVT rate decreased from 20.3–16.3%. The length of hospital stay increased in the late phase of the residents’ strike ( p = 0.001). During the strike, the proportion of patients classified as having minor stroke by NIHSS decreased at both admission ( p < 0.001) and discharge ( p = 0.002), while moderate and severe stroke cases increased (Table 1 ). Table 1 Baseline characteristics and clinical profiles of acute ischemic stroke patients Characteristics Total ( n = 2059) Before strike ( n = 1170) After strike ( n = 889) Before vs. after p Total ( n = 889) Early ( n = 301) Late ( n = 588) Early vs. late p Age, years, median 73 (64–81) 73 (63–81) 74 (65–82) 72 (65–81) 75 (65–82) 0.032 0.074 Sex, male 1213 (58.9) 691 (59.1) 522 (58.7) 179 (59.5) 343 (58.3) 0.800 0.912 Previous illness Atrial fibrillation/flutter 239 (11.6) 137 (11.7) 102 (11.5) 31 (10.3) 71 (12.1) 0.500 0.923 History of myocardial infarction 221 (10.7) 107 (9.1) 114 (12.8) 31 (10.3) 83 (14.1) 0.132 0.009 History of cerebrovascular accident 522 (25.4) 278 (23.8) 244 (27.4) 79 (26.2) 165 (28.1) 0.621 0.064 Hypertension 1266 (61.5) 695 (59.4) 571 (64.2) 184 (61.1) 387 (65.8) 0.192 0.029 Diabetes mellitus 621 (30.2) 349 (29.8) 272 (30.6) 95 (31.6) 177 (30.1) 0.711 0.744 Dyslipidemia 623 (30.3) 351 (30.0) 272 (30.6) 90 (29.9) 182 (31.0) 0.806 0.808 Anticoagulation 300 (14.6) 132 (11.3) 168 (19.0) 38 (12.7) 130 (22.3) 0.001 0.000 Transport modes 0.596 0.023 Public emergency medical service 1189 (57.7) 642 (54.9) 547 (61.5) 184 (61.1) 363 (61.7) Private emergency medical service 191 (9.3) 113 (9.7) 78 (8.8) 31 (10.3) 47 (8.0) General passenger car 679 (33.0) 415 (35.4) 264 (29.7) 86 (28.6) 178 (30.3) Management 0.005 0.008 Conservative 1497 (72.7) 830 (70.9) 667 (75.0) 221 (73.4) 446 (75.9) Intravenous thrombolysis 203 (9.9) 138 (11.8) 65 (7.3) 19 (6.3) 46 (7.8) Endovascular therapy 231 (11.2) 128 (10.9) 103 (11.6) 49 (16.3) 54 (9.2) Intravenous thrombolysis and endovascular therapy 128 (6.2) 74 (6.3) 54 (6.1) 12 (4.0) 42 (7.1) Hospital stay, days 7.0 (4.9–11.1) 6.9 (4.9–10.8) 7.2 (5.0–11.7) 6.8 (4.4–10.0) 7.6 (5.2–12.6) 0.001 0.144 In-hospital death 97 (4.7) 62 (5.3) 35 (3.9) 12 (4.0) 23 (3.9) 0.898 0.180 Mental state NIHSS at admission n = 1636 n = 926 n = 710 n = 209 n = 501 Score 5 (2–12) 5 (2–11) 5 (2–13) 5 (2–14) 5 (2–13) 0.946 0.054 Severity 0.363 0.000 Minor 733 (44.8) 439 (47.4) 294 (41.4) 93 (44.5) 201 (40.1) Moderate 612 (37.4) 335 (36.2) 277 (39.0) 71 (34.0) 206 (41.1) Moderate to severe 160 (9.8) 101 (10.9) 59 (8.3) 19 (9.1) 40 (8.0) Severe 131 (8.0) 51 (5.5) 80 (11.3) 26 (12.4) 54 (10.8) NIHSS at discharge n = 1151 n = 672 n = 479 n = 155 n = 324 Score 4 (2–10.5) 4 (2–9) 5 (2–12.5) 5 (2–12.5) 5 (2–12.25) 0.906 0.000 Severity 0.912 0.002 Minor 586 (50.9) 370 (55.1) 216 (45.1) 71 (45.8) 145 (44.8) Moderate 379 (32.9) 203 (30.2) 176 (36.7) 54 (34.8) 122 (37.7) Moderate to severe 67 (5.8) 42 (6.3) 25 (5.2) 8 (5.2) 17 (5.2) Severe 119 (10.3) 57 (8.5) 62 (12.9) 22 (14.2) 40 (12.3) NIHSS change (admission to discharge) n = 1106 n = 658 n = 448 n = 137 n = 311 Score −1 (− 4 to ) −1 (− 3 to 0) −1 (− 4 to 0) -1 (− 5 to 0) -1 (− 3.5 to 0) 0.446 0.197 MI, myocardial infarction; CVA, cerebrovascular accident; EMS, emergency medical service; IVT, intravenous thrombolysis; EVT, endovascular therapy; NIHSS, National Institutes of Health Stroke Scale. The time taken by public EMS was similar before and after the strike (92 min vs. 93 min, p = 0.454). However, onset-to-door time increased significantly for private EMS (209 min vs. 290 min, p = 0.004) and general passenger cars (261 min vs. 338 min, p = 0.002). When dividing the strike period into early and late phases, public EMS showed a longer onset-to-door time in the late phase compared to the early phase (82 min vs. 98 min, p = 0.003). Door-to-CT time decreased after the strike (23 min vs. 20 min, p < 0.001), while door-to-IVT and door-to-EVT times did not differ significantly (Table 2 ). Table 2 Time intervals from symptom onset to management in patients with acute ischemic stroke Time Total ( n = 2059) Before strike ( n = 1170) After strike Before vs. after p Total ( n = 889) Early ( n = 301) Late ( n = 588) Early vs. late p Onset-to-door time 147 (65–399.5) 146.5 (61–392.75) 150 (70.5–404) 134 (64.5–376.5) 157 (73–412) 0.357 0.348 Onset-to-door time 0.629 0.336 Less than 3 hours 1095 (55.2) 614 (55.2) 481 (55.2) 172 (57.7) 309 (53.9) 3 to 4.5 hours 202 (10.2) 112 (10.1) 90 (10.3) 32 (10.7) 58 (10.1) 4.5 to 6 hours 136 (6.9) 86 (7.7) 50 (5.7) 15 (5.0) 35 (6.1) More than 6 hours 550 (27.7) 300 (27.0) 250 (28.7) 79 (26.5) 171 (29.8) Onset-to-door time by transport mode Public EMS n = 1144 (57.7) n = 605 (54.4) n = 539 (61.9) n = 184 (61.7) n = 355 (62.0) Onset-to-door time 93 (52–226.3) 92 (48–258) 93 (57–203) 82 (49.8–139.3) 98 (59.5–229.5) 0.003 0.454 Private EMS n = 184 (9.3) n = 109 (9.8) n = 75 (8.6) n = 29 (9.7) n = 46 (8.0) Onset-to-door time 237.5 (142–441) 209 (125–351) 290 (178–479) 264 (176–429) 354 (180–533) 0.234 0.004 Passenger car n = 655 (33.0) n = 398 (35.8) n = 257 (29.5) n = 85 (28.5) n = 172 (30.0) Onset-to-door time 293 (132–553) 261 (117–519) 338 (162–651) 385 (223–874) 306 (147–563) 0.007 0.002 Door-to-CT time n = 2048 (99.5) n = 1160 (99.1) n = 888 (99.9) n = 301 (100.0) n = 587 (99.8) 22 (15–31) 23 (17–31) 20 (14–28) 19 (14–27) 20 (14–30) 0.168 < 0.001 20 minutes or less 888 (43.1) 447 (38.2) 441 (49.6) 154 (51.2) 287 (48.8) 0.284 < 0.001 Door-to-IVT time n = 328 (15.9) n = 210 (17.9) n = 118 (13.3) n = 31 (10.3) n = 87 (14.8) 41 (30–56) 41 (30–53) 42 (31–58) 40 (32–57) 42 (32–59) 0.622 0.241 60 minutes or less 268 (12.9) 176 (15.0) 90 (10.1) 25 (8.3) 65 (11.1) 0.344 0.065 Door-to-EVT time n = 358 (17.4) n = 201 (17.2) n = 157 (17.7) n = 61 (20.3) n = 96 (16.3) 87 (61–119.75) 86 (56–123) 87 (66–116) 90 (58–117) 86 (69–114) 0.854 0.532 90 minutes or less 191 (9.3) 106 (9.1) 85 (9.6) 32 (10.6) 53 (9.0) 0.431 0.438 Values are presented as median (range; unit: minutes). EMS, emergency medical service; CT, computed tomography; IVT, intravenous thrombolysis; EVT, endovascular therapy. Table 3 Factors affecting time to clinical management of acute ischemic stroke: a multivariable logistic regression analysis Crude OR 95% CI Adjusted OR 95% CI Door to CT scan Strike Before strike reference reference After strike, early 1.67* 1.30–2.16* 1.63* 1.22–2.19* After strike, late 1.53* 1.25–1.87* 1.40* 1.13–1.74* Transport mode General passenger car reference reference Private EMS 0.67* 0.46–0.98* 0.60* 0.40–0.90* Public EMS 2.78* 2.28–3.40* 2.42* 1.95–3.02* NIHSS at visit 1.04* 1.03–1.05* 1.03* 1.01–1.04* Door to IVT Strike Before strike reference reference After strike, early 0.81 0.31–2.11 0.63 0.23–1.78 After strike, late 0.57 0.31–1.05 0.48* 0.25–0.95* Transport mode General passenger car reference reference Private EMS 5.00 0.61–41.11 5.63 0.64–49.67 Public EMS 1.49 0.77–2.91 1.81 0.83–3.96 NIHSS at visit 1.02 0.98–1.06 1.01 0.96–1.06 Door to EVT Strike Before strike reference reference After strike, early 0.99 0.56–1.76 0.63 0.31–1.25 After strike, late 1.11 0.68–1.80 0.80 0.46–1.40 Transport mode General passenger car reference reference Private EMS 2.80* 1.01–7.77* 3.01 0.99–9.16 Public EMS 1.53 0.66–3.56 1.63 0.66–4.05 NIHSS at visit 1.05* 1.02–1.08 1.06* 1.02–1.09* * p < 0.005 was considered statistically significant. OR, odds ratio; CI, confidence interval; CT, computed tomography; EMS, emergency medical services; NIHSS, National Institutes of Health Stroke Scale; IVT, intravenous thrombolysis; EVT, endovascular therapy. Adjusted for age, sex, hypertension, diabetes, dyslipidemia, atrial fibrillation/flutter, cerebrovascular accident, anticoagulation, NIHSS at visit, transport mode, and strike period. Table 3 summarizes the results of a multivariable logistic regression analysis stratifying AIS patients by target time intervals for brain CT, IVT, and EVT (20 min for CT, 60 min for IVT, and 90 min for EVT). Independent factors associated with timely brain CT (≤ 20 min) included: early after-strike period (adjusted OR [aOR], 1.63; 95% CI, 1.22–2.19), late after-strike period (aOR, 1.40; 95% CI, 1.13–1.74), use of private EMS (aOR, 0.60; 95% CI, 0.40–0.90), use of public EMS (aOR, 2.42; 95% CI, 1.95–3.02), and NIHSS at visit (aOR, 1.03; 95% CI, 1.01–1.04). Timely door-to-IVT (≤ 60 min) was associated with late after-strike period (aOR, 0.48; 95% CI, 0.25–0.95). For door-to-EVT (≤ 90 min), NIHSS score at visit was significant (aOR, 1.06; 95% CI, 1.02–1.09). Discussion This study evaluated delays in treatment times for AIS patients during the Korean residents’ strike. The late phase of the strike was significantly associated with delays in prehospital transport by the 119 public EMS and a reduced rate of timely IVT. Both the early and late phases were linked to shorter door-to-CT times. However, the strike period did not have a statistically significant effect on door-to-EVT time. Previous studies have shown that residents’ strikes did not significantly affect patient mortality. Mortality rates did not differ by type of healthcare professional involved, country, or whether the strike was single- or multi-institutional [ 10 ]. A retrospective study of the 2020 Daegu residents’ strike also found no significant change in ED patient mortality rates [ 11 ]. Paradoxically, some studies reported a decrease in patient mortality during strike periods [ 12 ]. This has been attributed to the brief duration of most strikes and the implementation of contingency plans, such as deploying substitute staff and maintaining emergency services [ 10 , 12 ]. However, these prior studies mainly analyzed short-term strikes and their impact on mortality. Evidence on the effects of prolonged residents’ strikes, such as the recent strike in South Korea lasting over 10 months, is lacking. Furthermore, limited research has focused on outcomes for AIS patients during strike periods. To our knowledge, this study is the first to assess time delays in AIS management during a prolonged nationwide residents’ strike. On February 1, 2024, the South Korean government announced a policy package to improve essential healthcare services [ 7 ]. The plan includes annual increases in medical school admissions starting in 2025, aiming to address doctor shortages in underserved areas such as rural regions and essential fields [ 7 ]. However, many doctors argued that increasing doctor numbers alone would not address fundamental problems and might lower the quality of medical education and patient care [ 7 ]. As a result, the medical community collectively launched a strike. The Essential Medicine Policy Package, announced alongside the admissions increase, also sparked protests [ 13 ]. This package extends intern training before residency, makes residency training mandatory for medical licensing, and prohibits co-prescription of reimbursed and non-reimbursed treatments, creating uncertainty among medical students about their future practice environment [ 13 ]. Due to these concerns, residents and interns strongly opposed the policies and began submitting resignations on February 19, 2024. By March 8, more than 11,000 young doctors had joined the strike [ 7 ]. This collective action led to cancellation or postponement of regular procedures and treatments, and even emergency room services have been restricted, causing serious disruption to the healthcare system. During the residents’ strike in Korea, contingency plans were implemented in the early phase, helping to maintain timely hospital access. As a result, scene arrival-to-door time during the first three months of the strike, up to May 2024, was comparable to the pre-strike period. Onset-to-door time for patients transported by public EMS decreased to 82 minutes in the early phase, compared to 92 minutes before the strike. Door-to-CT time also decreased. During the strike, patients with mild symptoms were reluctant to visit hospitals, resulting in fewer AIS patients compared to previous years and increased case severity. Although overcrowded EDs are typically linked to longer ambulance travel distances and turnaround times, the strike reduced ED crowding, enabling public EMS to transport patients more quickly in the prehospital phase [ 14 ]. As seen in previous strikes, the absence of residents led to direct patient care by emergency medicine specialists, expediting triage and disposition [ 15 ]. This likely contributed to shorter diagnostic processing times during the in-hospital phase. Similarly, during the COVID-19 pandemic, despite potential delays from personal protective equipment and contact restrictions, reduced ED overcrowding allowed diagnostic tests and treatments to proceed without delay in the hospital phase [ 16 ]. However, after the initial three months, as remaining staff left and fatigue accumulated, hospitals increasingly limited acceptance of emergency patients. Consequently, delays arose in selecting appropriate hospitals for AIS patients at the prehospital stage, prolonging scene arrival-to-door times. Onset-to-door time for public EMS patients also increased. Furthermore, in-hospital treatment was delayed, and reperfusion therapy was often inadequately delivered. This study has inherent limitations. Most notably, it was a retrospective observational investigation confined to one metropolitan area (Daegu, South Korea), which may constrain the generalizability of its findings to different regions or healthcare environments. Second, long-term functional outcomes and mortality were not evaluated, as the study focused on acute treatment timelines and immediate stroke severity as measured by NIHSS scores. Third, potential confounders—including hospital-level policies, differences in strike participation, and changes in EMS prehospital protocols—were not fully accounted for. In summary, a prolonged residents’ strike in South Korea resulted in delays in AIS care, particularly during the late phase. The strike contributed to delays in both in-hospital IVT administration and prehospital patient transport. Abbreviations AIS Acute ischemic stroke EMS Emergency medical service CT computed tomography IVT Intravenous thrombolysis EVT Endovascular treatment ED Emergency department NIHSS Institutes of Health Stroke Scale EMR Electronic medical record OR Odds ratio CI Confidence interval Declarations Ethics approval and consent to participate This study received approval from the Institutional Review Board of Kyungpook National University Hospital (2025‑02‑041), and informed consent was waived in view of its retrospective design. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding There was no funding for this study. Author Contribution S.-H.L. was responsible for the conception and design of the study, data collection, statistical analysis, and drafting of the manuscript. H.W.R., as the corresponding author, co-initiated the study, contributed to data interpretation, and critically revised the manuscript. M.S.S. supported data collection and statistical analysis. S.-I.S. and Y.-H.H. contributed to the overall review and interpretation of the results. T.-K.K., J.Y.A., S.M., J.H.L., D.L., H.S.J., K.W.L., D.E.L., and Y.J.J. assisted with data collection and other study-related tasks. All authors read and approved the final version of the manuscript. Acknowledgements Not applicable. Data Availability The data sets used and/or analyzed during the current study are available from the corresponding author upon reasoned request. References Herpich F, Rincon F. Management of acute ischemic stroke. Crit Care Med. 2020;48(11):1654–63. https://doi.org/:10.1097/ccm.0000000000004597 . 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Utstein recommendation for emergency stroke care. Int J Stroke. 2020;15(5):555–64. https://doi.org/:10.1177/1747493020915135 . Anand SK, Benjamin WJ, Adapa AR, Park JV, Wilkinson DA, Daou BJ, et al. Trends in acute ischemic stroke treatments and mortality in the United States from 2012 to 2018. Neurosurg Focus. 2021;51(1):E2. https://doi.org/:10.3171/2021.4.Focus21117 . The Lancet Regional Health-Western P. Junior doctor strikes in South Korea: more doctors are needed? Lancet Reg Health West Pac. 2024;44:101056. https://doi.org/:10.1016/j.lanwpc.2024.101056 . Kwah LK, Diong J. National Institutes of Health Stroke Scale (NIHSS). J Physiother. 2014;60(1):61. https://doi.org/:10.1016/j.jphys.2013.12.012 . Warner JJ, Harrington RA, Sacco RL, Elkind MSV. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke. Stroke. 2019;50(12):3331–2. https://doi.org/:10.1161/strokeaha.119.027708 . 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Emergency department overcrowding and ambulance turnaround time. PLoS ONE. 2015;10(6):e0130758. https://doi.org/:10.1371/journal.pone.0130758 . Sim J, Choi Y, Jeong J. Changes in emergency department performance during strike of junior physicians in Korea. Emerg Med Int. 2021;2021:1786728. https://doi.org/:10.1155/2021/1786728 . Lee SH, Mun YH, Ryoo HW, Jin SC, Kim JH, Ahn JY, et al. Delays in the management of patients with acute ischemic stroke during the COVID-19 outbreak period: a multicenter study in Daegu, Korea. Emerg Med Int. 2021;2021:6687765. https://doi.org/:10.1155/2021/6687765 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7359511","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":504409121,"identity":"805c57f9-a61c-4bc3-b345-88ee2aaef1e2","order_by":0,"name":"Sang-Hun Lee","email":"","orcid":"","institution":"Keimyung University Dongsan Hospital, Keimyung University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Sang-Hun","middleName":"","lastName":"Lee","suffix":""},{"id":504409125,"identity":"6a7fef63-a112-424e-bf73-8587e105e1b0","order_by":1,"name":"Hyun Wook Ryoo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAp0lEQVRIiWNgGAWjYLCCDwcgNGMDsToYZ5CshZmHJC3mM5IPPrY5cyexgf3wA8aZe4jQInMjLdk458azxAaeNAPGDc+I0CIhkWMmnfPhcGIDQw4D44MDxGqxAGnhf0OKFoYbQC0SQFs2EKWF51myYc+Zw8ZtEs8MDsJCG78W9uSDD34cOyzbz5/88GEPMVoYBBIgNBsQE6WBgYGfSHWjYBSMglEwggEA1eY5ZgCA554AAAAASUVORK5CYII=","orcid":"","institution":"Kyungpook National University","correspondingAuthor":true,"prefix":"","firstName":"Hyun","middleName":"Wook","lastName":"Ryoo","suffix":""},{"id":504409129,"identity":"12e78d72-0380-40cc-bd88-ffba3a97329e","order_by":2,"name":"Tae-Kwon Kim","email":"","orcid":"","institution":"Keimyung University Dongsan Hospital, Keimyung University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Tae-Kwon","middleName":"","lastName":"Kim","suffix":""},{"id":504409134,"identity":"858ae952-2a48-4fe1-baf0-b6aac95c87a6","order_by":3,"name":"Jae Yun Ahn","email":"","orcid":"","institution":"Kyungpook National University","correspondingAuthor":false,"prefix":"","firstName":"Jae","middleName":"Yun","lastName":"Ahn","suffix":""},{"id":504409136,"identity":"ea30f35a-9861-4e21-b741-72be10c9fd53","order_by":4,"name":"Sungbae Moon","email":"","orcid":"","institution":"Kyungpook National University","correspondingAuthor":false,"prefix":"","firstName":"Sungbae","middleName":"","lastName":"Moon","suffix":""},{"id":504409138,"identity":"f3a3d19d-106a-40ca-9bf6-9046079cc67a","order_by":5,"name":"Jae Hyuk Lee","email":"","orcid":"","institution":"Kyungpook National University","correspondingAuthor":false,"prefix":"","firstName":"Jae","middleName":"Hyuk","lastName":"Lee","suffix":""},{"id":504409140,"identity":"814dcf33-3079-48bc-80c0-96f654678366","order_by":6,"name":"Dowon Lee","email":"","orcid":"","institution":"Kyungpook National University","correspondingAuthor":false,"prefix":"","firstName":"Dowon","middleName":"","lastName":"Lee","suffix":""},{"id":504409142,"identity":"a6634694-896a-412e-84d3-ebbce93972c2","order_by":7,"name":"Han Sol Jung","email":"","orcid":"","institution":"Yeungnam University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Han","middleName":"Sol","lastName":"Jung","suffix":""},{"id":504409144,"identity":"48e08df2-89ee-4337-9128-a23924f05637","order_by":8,"name":"Kyung Woo Lee","email":"","orcid":"","institution":"Catholic University of Daegu School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Kyung","middleName":"Woo","lastName":"Lee","suffix":""},{"id":504409146,"identity":"4ceb8c6e-3d40-4a2a-8f2a-6b47fd85169f","order_by":9,"name":"Dong Eun Lee","email":"","orcid":"","institution":"Kyungpook National University Chilgok Hospital, Kyungpook National University","correspondingAuthor":false,"prefix":"","firstName":"Dong","middleName":"Eun","lastName":"Lee","suffix":""},{"id":504409147,"identity":"76a8816f-ea7b-4e6a-b664-b8515b9989a7","order_by":10,"name":"Yeon Joo Jo","email":"","orcid":"","institution":"Kyungpook National University Chilgok Hospital, Kyungpook National University","correspondingAuthor":false,"prefix":"","firstName":"Yeon","middleName":"Joo","lastName":"Jo","suffix":""},{"id":504409148,"identity":"cf005748-831d-4326-a78b-cbd18457e28c","order_by":11,"name":"Sung-Il Sohn","email":"","orcid":"","institution":"Keimyung University Dongsan Hospital, Keimyung University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Sung-Il","middleName":"","lastName":"Sohn","suffix":""},{"id":504409149,"identity":"58ff1b5d-bdbf-4422-ba36-3cfa18dd2c92","order_by":12,"name":"Yang-Ha Hwang","email":"","orcid":"","institution":"Kyungpook National University Hospital, Kyungpook National University","correspondingAuthor":false,"prefix":"","firstName":"Yang-Ha","middleName":"","lastName":"Hwang","suffix":""},{"id":504409150,"identity":"b3b81e9d-f660-4caa-9ff6-e55def54f7b6","order_by":13,"name":"Min Seok Shin","email":"","orcid":"","institution":"Daegu Emergency Medicine Collaboration Committee","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"Seok","lastName":"Shin","suffix":""}],"badges":[],"createdAt":"2025-08-12 23:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7359511/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7359511/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89840145,"identity":"5b32da90-3900-4ea7-ac95-1090698dcff0","added_by":"auto","created_at":"2025-08-25 15:11:46","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":256877,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of study patients.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7359511/v1/c9c09e573c76ad2af06808f7.jpeg"},{"id":89840146,"identity":"1226937f-8f47-468e-8962-f5f5ebb7cae1","added_by":"auto","created_at":"2025-08-25 15:11:46","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":187404,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in the response time and scene arrival-to-door time for acute ischemic stroke patients.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7359511/v1/e410a0daa98d47d751e21a65.jpeg"},{"id":89842174,"identity":"2d8bfba3-6e95-451b-8a9d-02246db4f129","added_by":"auto","created_at":"2025-08-25 15:35:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1710801,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7359511/v1/8d4bab5b-2306-4573-a7c5-4c621f3061b2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of a prolonged nationwide residents’ strike on acute ischemic stroke care in a metropolitan city","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAcute ischemic stroke (AIS) is a time-sensitive condition, and rapid management in both prehospital and in-hospital phases is essential for optimal clinical outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In the prehospital phase, prompt recognition of AIS onset and expeditious transfer to the hospital, including pre-notification by professional emergency medical services (EMSs), are critical [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In the in-hospital phase, rapid brain imaging, such as computed tomography (CT), and Prompt initiation of intravenous thrombolysis (IVT) and endovascular treatment (EVT) is essential within the appropriate therapeutic window [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Management of AIS involves sequential, interdependent steps, and prompt intervention at each stage is necessary to provide optimal care [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These coordinated efforts have improved outcomes for patients with AIS [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn February 2024, South Korean resident physicians commenced a walkout in response to the government\u0026rsquo;s proposed healthcare reform [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Consequently, major hospitals faced physician shortages, leading to delays and cancellations of outpatient services and procedures, and restrictions in accepting and treating patients in emergency departments (EDs) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Due to these limitations, patients with acute AIS no longer benefited from previously established advanced treatment systems.\u003c/p\u003e\u003cp\u003eIt is presumed that the residents\u0026rsquo; strike caused delays in both prehospital and in-hospital treatment for AIS patients; however, research on this issue is lacking. Therefore, we analyzed the clinical outcomes of AIS patients during the residents\u0026rsquo; strike in Daegu, South Korea.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy overview and enrollment\u003c/h2\u003e\u003cp\u003eWe conducted a retrospective before-and-after comparative study in Daegu, the fourth-largest metropolitan city in South Korea, encompassing the periods from March 1 to December 31 in 2023 and 2024. The study encompassed all 119 ambulances operating across approximately 50 fire safety centers. All major hospitals in Daegu participated, including two regional emergency medical centers and four local emergency medical centers.\u003c/p\u003e\u003cp\u003eThe study population comprised adults (\u0026ge;\u0026thinsp;18 years) who visited the ED with AIS, with symptom onset within 24 hours of last known well. Patients eligible for reperfusion therapy who declined treatment were excluded. Cases were also excluded if relevant data were unavailable or if medical records could not be verified.\u003c/p\u003e\u003cp\u003eTo compare periods before and after the residents\u0026rsquo; strike, AIS patients from 2023 and 2024 were analyzed. To evaluate the early and late phases of the strike, the year 2024 was divided into two subgroups: March to May (first three months) and June to December.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDefinition and measurement\u003c/h3\u003e\n\u003cp\u003ePatients were classified by mode of hospital arrival. The public EMS group consisted of patients who were taken directly from the scene by the national 119 ambulance service, which is operated by the fire department in South Korea. The private EMS group comprised patients initially suspected or diagnosed at another hospital and subsequently transferred by private ambulance. The general passenger car group consisted of patients who arrived using private vehicles without ambulance services.\u003c/p\u003e\u003cp\u003eNeurological evaluation was conducted with the National Institutes of Health Stroke Scale (NIHSS), which was recorded at both admission and discharge [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Stroke severity was classified into four categories based on NIHSS scores: mild (one to four), moderate (five to fifteen), moderately severe (sixteen to twenty), and severe (twenty‑one to forty‑two) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSymptom onset time was defined as the first abnormal time, and onset-to-door time was measured from first the abnormal time. Door time referred to the exact time at which the patient completed registration at the ED following arrival. Key time metrics for diagnosis and treatment were documented upon hospital arrival, encompassing the intervals from door to CT imaging, IVT, and EVT. CT time was recorded as the timestamp when the first scan image was generated. IVT time was recorded at the moment tissue plasminogen activator was administered, and EVT time corresponded to the start of arterial puncture.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003ePatient data with ICD-10-CM diagnostic codes I60\u0026ndash;I64 (the U.S. clinical modification of the 10th revision of the International Classification of Diseases) were extracted from the electronic medical records (EMRs) of the six participating hospitals. Codes were assigned by on-duty neurologists based on final diagnoses supported by examination and imaging. Data for the study cohort were obtained from hospital EMRs and 119 EMS run sheets from Daegu.\u003c/p\u003e\u003cp\u003eWe collected data on age, sex, medical history, mode of arrival, symptom onset time, length of hospital stay, in-hospital mortality, mental status, neurological assessments, and treatments from EMRs. For patients transported by public EMS, response time and scene-to-door time were extracted from EMS run sheets.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eFor continuous variables, data were expressed as medians with interquartile ranges, and group comparisons were performed using Student\u0026rsquo;s t‑test or, when appropriate for non‑normal distributions, the Mann\u0026ndash;Whitney U test. For categorical variables, data were summarized as frequencies with corresponding percentages, and intergroup comparisons employed the chi‑square test or Fisher\u0026rsquo;s exact test when indicated.\u003c/p\u003e\u003cp\u003eTo assess the association between baseline characteristics and the impact of the residents\u0026rsquo; strike on management timeliness\u0026mdash;such as brain CT, IVT, and EVT\u0026mdash;univariate logistic regression was initially performed. In accordance with American Heart Association/American Stroke Association guidelines, the times from door to CT, IVT, and EVT were dichotomized using thresholds of 20, 60, and 90 minutes, respectively [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMultivariable logistic regression was applied to determine factors influencing the timely completion of CT and reperfusion treatments, with covariates including age, sex, comorbidities, initial NIHSS score, transport modality, and the presence and timing of the resident strike. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to present the results. Strike timing was categorized as early or late, with the pre-strike period as the reference.\u003c/p\u003e\u003cp\u003eStatistical analyses were carried out with SPSS Statistics for Windows, version 29.0.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the study period, 2,059 AIS patients within 24 hours of last known normal presented to six major hospitals in Daegu city. Among these, 1,170 patients (56.8%) presented in 2023, before the residents\u0026rsquo; strike, and 889 patients (43.2%) presented in 2024, after the strike began (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the After period, the time from on-site arrival to hospital transport increased following the initial three months (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Based on this trend, the strike period was divided into early and late phases (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In the first three months of the strike, 301 AIS patients (14.6%) presented, while 588 patients (28.6%) presented in the later phase (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe median age of the study population was 73 years, and 1,213 patients (58.9%) were male. Anticoagulant use was more common during the residents\u0026rsquo; strike (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), especially in the later phase (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). Other comorbidities did not differ significantly between the pre-strike and post-strike periods. During the strike, a higher proportion of patients arrived via public EMS, while the use of private EMS and general passenger vehicles declined (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023). Regarding treatment, conservative management increased during the strike, while IVT alone and combined IVT with EVT decreased (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008). Comparing the early and late phases, conservative management further increased in the late phase. In contrast, the use of IVT alone and combined IVT with EVT rose, whereas EVT alone declined (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005). The proportion of patients receiving IVT increased from 10.3% in the early phase to 14.9% in the late phase, while the EVT rate decreased from 20.3\u0026ndash;16.3%. The length of hospital stay increased in the late phase of the residents\u0026rsquo; strike (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). During the strike, the proportion of patients classified as having minor stroke by NIHSS decreased at both admission (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and discharge (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), while moderate and severe stroke cases increased (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics and clinical profiles of acute ischemic stroke patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2059)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBefore strike\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1170)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c9\" namest=\"c4\"\u003e\u003cp\u003eAfter strike (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;889)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBefore vs. after\u003c/p\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;889)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEarly\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;301)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLate\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;588)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003eEarly vs. late\u003c/p\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, years, median\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (64\u0026ndash;81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73 (63\u0026ndash;81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e74 (65\u0026ndash;82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72 (65\u0026ndash;81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75 (65\u0026ndash;82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.074\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex, male\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1213 (58.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e691 (59.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e522 (58.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e179 (59.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e343 (58.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e0.800\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.912\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAtrial fibrillation/flutter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e239 (11.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e137 (11.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e102 (11.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31 (10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e71 (12.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e0.500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.923\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of myocardial infarction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e221 (10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107 (9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e114 (12.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31 (10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e83 (14.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e0.132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of cerebrovascular accident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e522 (25.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e278 (23.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e244 (27.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e79 (26.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e165 (28.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e0.621\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.064\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1266 (61.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e695 (59.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e571 (64.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e184 (61.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e387 (65.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e0.192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e621 (30.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e349 (29.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e272 (30.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95 (31.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e177 (30.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e0.711\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.744\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDyslipidemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e623 (30.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e351 (30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e272 (30.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e90 (29.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e182 (31.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e0.806\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.808\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnticoagulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e300 (14.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e132 (11.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e168 (19.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e38 (12.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e130 (22.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransport modes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.596\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e0.023\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePublic emergency medical service\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1189 (57.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e642 (54.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e547 (61.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e184 (61.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e363 (61.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" morerows=\"2\" nameend=\"c9\" namest=\"c7\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate emergency medical service\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e191 (9.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e113 (9.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78 (8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31 (10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e47 (8.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeneral passenger car\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e679 (33.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e415 (35.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e264 (29.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e86 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e178 (30.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManagement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConservative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1497 (72.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e830 (70.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e667 (75.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e221 (73.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e446 (75.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" morerows=\"3\" nameend=\"c9\" namest=\"c7\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntravenous thrombolysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e203 (9.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e138 (11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65 (7.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19 (6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e46 (7.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEndovascular therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e231 (11.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e128 (10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e103 (11.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e49 (16.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e54 (9.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntravenous thrombolysis and endovascular therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e128 (6.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74 (6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12 (4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e42 (7.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital stay, days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.0 (4.9\u0026ndash;11.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.9 (4.9\u0026ndash;10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.2 (5.0\u0026ndash;11.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.8 (4.4\u0026ndash;10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.6 (5.2\u0026ndash;12.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.144\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIn-hospital death\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e97 (4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62 (5.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35 (3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12 (4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23 (3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e0.898\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.180\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental state\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNIHSS at admission\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1636\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;926\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;710\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;501\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScore\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (2\u0026ndash;12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (2\u0026ndash;11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (2\u0026ndash;13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (2\u0026ndash;14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5 (2\u0026ndash;13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e0.946\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.054\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeverity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e0.363\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMinor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e733 (44.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e439 (47.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e294 (41.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e93 (44.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e201 (40.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" morerows=\"3\" nameend=\"c9\" namest=\"c7\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e612 (37.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e335 (36.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e277 (39.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e71 (34.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e206 (41.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate to severe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e160 (9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e101 (10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19 (9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e40 (8.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e131 (8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51 (5.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80 (11.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26 (12.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e54 (10.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNIHSS at discharge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;672\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;479\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;324\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScore\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (2\u0026ndash;10.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (2\u0026ndash;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (2\u0026ndash;12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (2\u0026ndash;12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5 (2\u0026ndash;12.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e0.906\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeverity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e0.912\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMinor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e586 (50.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e370 (55.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e216 (45.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e71 (45.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e145 (44.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" morerows=\"3\" nameend=\"c9\" namest=\"c7\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e379 (32.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e203 (30.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e176 (36.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e54 (34.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e122 (37.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate to severe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67 (5.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42 (6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 (5.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (5.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17 (5.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e119 (10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57 (8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62 (12.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22 (14.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e40 (12.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNIHSS change (admission to discharge)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;658\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;448\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;311\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScore\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;1 (\u0026minus;\u0026thinsp;4 to )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;1 (\u0026minus;\u0026thinsp;3 to 0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;1 (\u0026minus;\u0026thinsp;4 to 0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-1 (\u0026minus;\u0026thinsp;5 to 0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1 (\u0026minus;\u0026thinsp;3.5 to 0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e0.446\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.197\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003eMI, myocardial infarction; CVA, cerebrovascular accident; EMS, emergency medical service; IVT, intravenous thrombolysis; EVT, endovascular therapy; NIHSS, National Institutes of Health Stroke Scale.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe time taken by public EMS was similar before and after the strike (92 min vs. 93 min, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.454). However, onset-to-door time increased significantly for private EMS (209 min vs. 290 min, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004) and general passenger cars (261 min vs. 338 min, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002). When dividing the strike period into early and late phases, public EMS showed a longer onset-to-door time in the late phase compared to the early phase (82 min vs. 98 min, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). Door-to-CT time decreased after the strike (23 min vs. 20 min, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while door-to-IVT and door-to-EVT times did not differ significantly (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTime intervals from symptom onset to management in patients with acute ischemic stroke\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTotal (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2059)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBefore strike (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1170)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e\u003cp\u003eAfter strike\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBefore vs. after\u003c/p\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;889)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEarly (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;301)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLate (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;588)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eEarly vs. late\u003c/p\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnset-to-door time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e147\u003c/p\u003e\u003cp\u003e(65\u0026ndash;399.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e146.5\u003c/p\u003e\u003cp\u003e(61\u0026ndash;392.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e150\u003c/p\u003e\u003cp\u003e(70.5\u0026ndash;404)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e134\u003c/p\u003e\u003cp\u003e(64.5\u0026ndash;376.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e157\u003c/p\u003e\u003cp\u003e(73\u0026ndash;412)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.357\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.348\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnset-to-door time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.629\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.336\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLess than 3 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1095 (55.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e614 (55.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e481 (55.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e172 (57.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e309 (53.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 to 4.5 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e202 (10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e112 (10.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e90 (10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32 (10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e58 (10.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4.5 to 6 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e136 (6.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86 (7.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50 (5.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15 (5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e35 (6.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMore than 6 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e550 (27.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e300 (27.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e250 (28.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e79 (26.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e171 (29.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnset-to-door time by transport mode\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePublic EMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1144 (57.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;605 (54.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;539 (61.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;184 (61.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;355 (62.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnset-to-door time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e93 (52\u0026ndash;226.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92 (48\u0026ndash;258)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93 (57\u0026ndash;203)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e82 (49.8\u0026ndash;139.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e98 (59.5\u0026ndash;229.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.454\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate EMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;184 (9.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;109 (9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;75 (8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;29 (9.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;46 (8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnset-to-door time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e237.5 (142\u0026ndash;441)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e209 (125\u0026ndash;351)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e290 (178\u0026ndash;479)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e264 (176\u0026ndash;429)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e354 (180\u0026ndash;533)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.234\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePassenger car\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;655 (33.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;398 (35.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;257 (29.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;85 (28.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;172 (30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnset-to-door time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e293 (132\u0026ndash;553)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e261 (117\u0026ndash;519)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e338 (162\u0026ndash;651)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e385 (223\u0026ndash;874)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e306 (147\u0026ndash;563)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDoor-to-CT time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2048 (99.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1160 (99.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;888 (99.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;301 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;587 (99.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (15\u0026ndash;31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (17\u0026ndash;31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20 (14\u0026ndash;28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19 (14\u0026ndash;27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20 (14\u0026ndash;30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20 minutes or less\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e888 (43.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e447 (38.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e441 (49.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e154 (51.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e287 (48.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.284\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDoor-to-IVT time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;328 (15.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;210 (17.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;118 (13.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;31 (10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;87 (14.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (30\u0026ndash;56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41 (30\u0026ndash;53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42 (31\u0026ndash;58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40 (32\u0026ndash;57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e42 (32\u0026ndash;59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.622\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.241\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60 minutes or less\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e268 (12.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e176 (15.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e90 (10.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e65 (11.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.344\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDoor-to-EVT time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;358 (17.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;201 (17.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;157 (17.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;61 (20.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;96 (16.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87 (61\u0026ndash;119.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86 (56\u0026ndash;123)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87 (66\u0026ndash;116)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e90 (58\u0026ndash;117)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e86 (69\u0026ndash;114)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.854\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.532\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e90 minutes or less\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e191 (9.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e106 (9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85 (9.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32 (10.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e53 (9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.431\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.438\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eValues are presented as median (range; unit: minutes).\u003c/p\u003e\u003cp\u003eEMS, emergency medical service; CT, computed tomography; IVT, intravenous thrombolysis; EVT, endovascular therapy.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e\u003cp\u003eTable\u0026nbsp;3 Factors affecting time to clinical management of acute ischemic stroke: a multivariable logistic regression analysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eCrude OR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eAdjusted OR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDoor to CT scan\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStrike\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBefore strike\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ereference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003ereference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAfter strike, early\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1.67*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.30\u0026ndash;2.16*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e1.63*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e1.22\u0026ndash;2.19*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAfter strike, late\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1.53*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.25\u0026ndash;1.87*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e1.40*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e1.13\u0026ndash;1.74*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransport mode\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeneral passenger car\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ereference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003ereference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate EMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.67*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.46\u0026ndash;0.98*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.60*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.40\u0026ndash;0.90*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePublic EMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e2.78*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2.28\u0026ndash;3.40*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e2.42*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e1.95\u0026ndash;3.02*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNIHSS at visit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1.04*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.03\u0026ndash;1.05*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e1.03*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e1.01\u0026ndash;1.04*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDoor to IVT\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStrike\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBefore strike\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ereference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003ereference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAfter strike, early\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.31\u0026ndash;2.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.23\u0026ndash;1.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAfter strike, late\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.31\u0026ndash;1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.48*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.25\u0026ndash;0.95*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eTransport mode\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eGeneral passenger car\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003ereference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003ereference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePrivate EMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.61\u0026ndash;41.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e5.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e0.64\u0026ndash;49.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePublic EMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.77\u0026ndash;2.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e1.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e0.83\u0026ndash;3.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNIHSS at visit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.98\u0026ndash;1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e0.96\u0026ndash;1.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDoor to EVT\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eStrike\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eBefore strike\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003ereference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003ereference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAfter strike, early\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.56\u0026ndash;1.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e0.31\u0026ndash;1.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAfter strike, late\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.68\u0026ndash;1.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e0.46\u0026ndash;1.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransport mode\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeneral passenger car\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ereference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003ereference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate EMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e2.80*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.01\u0026ndash;7.77*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e3.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.99\u0026ndash;9.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePublic EMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.66\u0026ndash;3.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e1.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.66\u0026ndash;4.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNIHSS at visit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1.05*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.02\u0026ndash;1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e1.06*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e1.02\u0026ndash;1.09*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e\u003cp\u003e*\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.005 was considered statistically significant.\u003c/p\u003e\u003cp\u003eOR, odds ratio; CI, confidence interval; CT, computed tomography; EMS, emergency medical services; NIHSS, National Institutes of Health Stroke Scale; IVT, intravenous thrombolysis; EVT, endovascular therapy.\u003c/p\u003e\u003cp\u003eAdjusted for age, sex, hypertension, diabetes, dyslipidemia, atrial fibrillation/flutter, cerebrovascular accident, anticoagulation, NIHSS at visit, transport mode, and strike period.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;3 summarizes the results of a multivariable logistic regression analysis stratifying AIS patients by target time intervals for brain CT, IVT, and EVT (20 min for CT, 60 min for IVT, and 90 min for EVT). Independent factors associated with timely brain CT (\u0026le;\u0026thinsp;20 min) included: early after-strike period (adjusted OR [aOR], 1.63; 95% CI, 1.22\u0026ndash;2.19), late after-strike period (aOR, 1.40; 95% CI, 1.13\u0026ndash;1.74), use of private EMS (aOR, 0.60; 95% CI, 0.40\u0026ndash;0.90), use of public EMS (aOR, 2.42; 95% CI, 1.95\u0026ndash;3.02), and NIHSS at visit (aOR, 1.03; 95% CI, 1.01\u0026ndash;1.04). Timely door-to-IVT (\u0026le;\u0026thinsp;60 min) was associated with late after-strike period (aOR, 0.48; 95% CI, 0.25\u0026ndash;0.95). For door-to-EVT (\u0026le;\u0026thinsp;90 min), NIHSS score at visit was significant (aOR, 1.06; 95% CI, 1.02\u0026ndash;1.09).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated delays in treatment times for AIS patients during the Korean residents\u0026rsquo; strike. The late phase of the strike was significantly associated with delays in prehospital transport by the 119 public EMS and a reduced rate of timely IVT. Both the early and late phases were linked to shorter door-to-CT times. However, the strike period did not have a statistically significant effect on door-to-EVT time.\u003c/p\u003e\u003cp\u003ePrevious studies have shown that residents\u0026rsquo; strikes did not significantly affect patient mortality. Mortality rates did not differ by type of healthcare professional involved, country, or whether the strike was single- or multi-institutional [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. A retrospective study of the 2020 Daegu residents\u0026rsquo; strike also found no significant change in ED patient mortality rates [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Paradoxically, some studies reported a decrease in patient mortality during strike periods [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This has been attributed to the brief duration of most strikes and the implementation of contingency plans, such as deploying substitute staff and maintaining emergency services [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, these prior studies mainly analyzed short-term strikes and their impact on mortality. Evidence on the effects of prolonged residents\u0026rsquo; strikes, such as the recent strike in South Korea lasting over 10 months, is lacking. Furthermore, limited research has focused on outcomes for AIS patients during strike periods. To our knowledge, this study is the first to assess time delays in AIS management during a prolonged nationwide residents\u0026rsquo; strike.\u003c/p\u003e\u003cp\u003eOn February 1, 2024, the South Korean government announced a policy package to improve essential healthcare services [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The plan includes annual increases in medical school admissions starting in 2025, aiming to address doctor shortages in underserved areas such as rural regions and essential fields [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, many doctors argued that increasing doctor numbers alone would not address fundamental problems and might lower the quality of medical education and patient care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. As a result, the medical community collectively launched a strike. The Essential Medicine Policy Package, announced alongside the admissions increase, also sparked protests [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This package extends intern training before residency, makes residency training mandatory for medical licensing, and prohibits co-prescription of reimbursed and non-reimbursed treatments, creating uncertainty among medical students about their future practice environment [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Due to these concerns, residents and interns strongly opposed the policies and began submitting resignations on February 19, 2024. By March 8, more than 11,000 young doctors had joined the strike [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This collective action led to cancellation or postponement of regular procedures and treatments, and even emergency room services have been restricted, causing serious disruption to the healthcare system.\u003c/p\u003e\u003cp\u003eDuring the residents\u0026rsquo; strike in Korea, contingency plans were implemented in the early phase, helping to maintain timely hospital access. As a result, scene arrival-to-door time during the first three months of the strike, up to May 2024, was comparable to the pre-strike period. Onset-to-door time for patients transported by public EMS decreased to 82 minutes in the early phase, compared to 92 minutes before the strike. Door-to-CT time also decreased. During the strike, patients with mild symptoms were reluctant to visit hospitals, resulting in fewer AIS patients compared to previous years and increased case severity. Although overcrowded EDs are typically linked to longer ambulance travel distances and turnaround times, the strike reduced ED crowding, enabling public EMS to transport patients more quickly in the prehospital phase [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. As seen in previous strikes, the absence of residents led to direct patient care by emergency medicine specialists, expediting triage and disposition [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This likely contributed to shorter diagnostic processing times during the in-hospital phase. Similarly, during the COVID-19 pandemic, despite potential delays from personal protective equipment and contact restrictions, reduced ED overcrowding allowed diagnostic tests and treatments to proceed without delay in the hospital phase [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, after the initial three months, as remaining staff left and fatigue accumulated, hospitals increasingly limited acceptance of emergency patients. Consequently, delays arose in selecting appropriate hospitals for AIS patients at the prehospital stage, prolonging scene arrival-to-door times. Onset-to-door time for public EMS patients also increased. Furthermore, in-hospital treatment was delayed, and reperfusion therapy was often inadequately delivered.\u003c/p\u003e\u003cp\u003eThis study has inherent limitations. Most notably, it was a retrospective observational investigation confined to one metropolitan area (Daegu, South Korea), which may constrain the generalizability of its findings to different regions or healthcare environments. Second, long-term functional outcomes and mortality were not evaluated, as the study focused on acute treatment timelines and immediate stroke severity as measured by NIHSS scores. Third, potential confounders\u0026mdash;including hospital-level policies, differences in strike participation, and changes in EMS prehospital protocols\u0026mdash;were not fully accounted for.\u003c/p\u003e\u003cp\u003eIn summary, a prolonged residents\u0026rsquo; strike in South Korea resulted in delays in AIS care, particularly during the late phase. The strike contributed to delays in both in-hospital IVT administration and prehospital patient transport.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAIS Acute ischemic stroke\u003c/p\u003e\u003cp\u003eEMS Emergency medical service\u003c/p\u003e\u003cp\u003eCT computed tomography\u003c/p\u003e\u003cp\u003eIVT Intravenous thrombolysis\u003c/p\u003e\u003cp\u003eEVT Endovascular treatment\u003c/p\u003e\u003cp\u003eED Emergency department\u003c/p\u003e\u003cp\u003eNIHSS Institutes of Health Stroke Scale\u003c/p\u003e\u003cp\u003eEMR Electronic medical record\u003c/p\u003e\u003cp\u003eOR Odds ratio\u003c/p\u003e\u003cp\u003eCI Confidence interval\u003c/p\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e This study received approval from the Institutional Review Board of Kyungpook National University Hospital (2025‑02‑041), and informed consent was waived in view of its retrospective design.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThere was no funding for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.-H.L. was responsible for the conception and design of the study, data collection, statistical analysis, and drafting of the manuscript. H.W.R., as the corresponding author, co-initiated the study, contributed to data interpretation, and critically revised the manuscript. M.S.S. supported data collection and statistical analysis. S.-I.S. and Y.-H.H. contributed to the overall review and interpretation of the results. T.-K.K., J.Y.A., S.M., J.H.L., D.L., H.S.J., K.W.L., D.E.L., and Y.J.J. assisted with data collection and other study-related tasks. All authors read and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data sets used and/or analyzed during the current study are available from the corresponding author upon reasoned request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHerpich F, Rincon F. Management of acute ischemic stroke. 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Emerg Med Int. 2021;2021:1786728. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/:10.1155/2021/1786728\u003c/span\u003e\u003cspan address=\":10.1155/2021/1786728\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee SH, Mun YH, Ryoo HW, Jin SC, Kim JH, Ahn JY, et al. Delays in the management of patients with acute ischemic stroke during the COVID-19 outbreak period: a multicenter study in Daegu, Korea. Emerg Med Int. 2021;2021:6687765. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/:10.1155/2021/6687765\u003c/span\u003e\u003cspan address=\":10.1155/2021/6687765\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Stroke, Emergency medical services, Strike, Employee","lastPublishedDoi":"10.21203/rs.3.rs-7359511/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7359511/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAcute ischemic stroke (AIS) requires timely management in both prehospital and in-hospital phases to optimize outcomes. In 2024, South Korea experienced a prolonged nationwide residents\u0026rsquo; strike that disrupted the healthcare system, potentially affecting AIS management. This study evaluated the impact of the residents\u0026rsquo; strike on time-to-management outcomes in patients with AIS.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe performed a retrospective multicenter study of AIS patients who presented within 24 hours of symptom onset to six major hospitals in Daegu, South Korea, between March and December in both 2023 and 2024. Clinical characteristics and management times were compared according to strike status and further analyzed by dividing patients into early and late strike phases.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 2,059 AIS patients were included. During the late phase of the residents\u0026rsquo; strike, patients transported by 119 public emergency medical service dispatches experienced delayed hospital arrival (83 minutes vs. 98 minutes, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). Logistic regression analysis further demonstrated that the late phase of the strike was associated with significant delays in intravenous thrombolysis initiation (adjusted odds ratio, 0.48; 95% confidence interval, 0.25\u0026ndash;0.95).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe prolonged residents\u0026rsquo; strike in South Korea resulted in delays in AIS management, particularly during the late phase, impacting both prehospital transport by 119 public emergency medical service dispatches and timely intravenous thrombolysis administration.\u003c/p\u003e","manuscriptTitle":"Impact of a prolonged nationwide residents’ strike on acute ischemic stroke care in a metropolitan city","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-25 15:11:41","doi":"10.21203/rs.3.rs-7359511/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-22T05:10:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-19T11:36:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-10T09:26:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-07T07:57:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"57380572780069664752008811612887542137","date":"2025-09-01T13:24:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"177190979369416293063514400291853364264","date":"2025-09-01T06:38:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256527616228587837793086278344063373639","date":"2025-08-31T06:47:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"40054854362569258818728015811182864806","date":"2025-08-18T05:05:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-17T16:25:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-13T11:29:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-13T11:29:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Emergency Medicine","date":"2025-08-12T23:48:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d3c2949b-f96e-4291-9571-74054578e3b9","owner":[],"postedDate":"August 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T01:38:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-25 15:11:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7359511","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7359511","identity":"rs-7359511","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}