Stroke, Vol 24, 1805-1810, Copyright © 1993 by American Heart Association
E Feldmann, N Gordon, JM Brooks, LM Brass, PB Fayad, KL Sawaya, F Nazareno and SR Levine
BACKGROUND AND PURPOSE: Patients with stroke symptoms commonly delay many
hours before seeking medical attention. We sought to explore the factors
associated with early presentation of stroke patients to physicians.
METHODS: We prospectively studied 100 consecutive acute stroke patients
presenting to three large, urban medical centers. Using a standardized,
structured interview and chart review, we assessed patient education about
stroke, risk factors, clinical features of the stroke, source of stroke
recognition, and timing of presentation. We did not study the distance from
the site of stroke onset to the site of physician contact. RESULTS: Stroke
onset time was known in 96 of the patients. Mean patient age was 71.3
years, 79% had at least one stroke risk factor, 26% had prior transient
ischemic attack, 19% had prior stroke, 74% had some high school education,
and 86% had regular physicians. Only 8% had been previously educated about
stroke symptoms. Eighty one percent of strokes were ischemic. The mean time
to physician contact was 13.4 +/- 2.3 hours (median, 4.0 hours) and to
neurologist contact was 21.2 +/- 2.9 hours. A skewed distribution of
presentation times accounts for the mean-median differences. A small number
of patients presenting very late could have an effect on the correlations
between presentation time and the variables studied. Early presentation
time was associated with increased age, the sudden onset of a stable
deficit, and recognition that the symptoms signified stroke. Only the
sudden onset of a stable deficit correlated independently with early
presentation time (P = .0048). There was no correlation between
presentation time and prior transient ischemic attack or stroke, headache,
vomiting, loss of consciousness or seizures at onset, or stroke subtype,
but a type II error could not be excluded. CONCLUSIONS: Despite their
education level, regular health care, and risk factors, especially prior
stroke and transient ischemic attack, these patients were not knowledgeable
about stroke and delayed many hours before contacting physicians. The
course of symptoms and recognition that they signified stroke were
associated with earlier presentation. Patient education focused on groups
at risk may hasten the presentation and treatment of acute stroke.
ARTICLES
Factors associated with early presentation of acute stroke
Department of Clinical Neurosciences, Brown University School of Medicine, Providence, RI.
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