Stroke, Vol 25, 2132-2137, Copyright © 1994 by American Heart Association
WG Barsan, TG Brott, JP Broderick, EC Haley Jr, DE Levy and JR Marler
BACKGROUND AND PURPOSE: As part of the recruitment efforts for the National
Institutes of Health Tissue Plasminogen Activator Pilot Study, public
education and awareness campaigns were conducted to encourage early
hospital arrival. We evaluated the change in arrival times during the
course of the study for all stroke patients, including those who were not
entered into study. METHODS: Data were gathered on all patients presenting
within 24 hours of stroke onset to all of the study hospitals. Coincident
with the start of the study, educational and promotional programs, which
stressed signs and symptoms of stroke and the need to call 911, were
presented to physicians, paramedical personnel, and the public. The study
was divided into four quartiles to analyze differences in time to hospital
arrival and use of 911. RESULTS: Of 2099 patients screened, time data were
available on 1116. During the course of the study, the mean time from
symptom onset to hospital arrival declined significantly (3.2 hours versus
1.5 hours). Patients arrived for treatment sooner at community hospitals
than at university/teaching hospitals. The use of 911 increased from 39% in
the first quartile of the study to 60% in the fourth quartile. This was a
consistent finding in all study sites. Increased use of 911 was seen almost
exclusively in patients with nonhemorrhagic stroke. CONCLUSIONS: Times from
stroke onset to hospital arrival decreased significantly during the course
of the National Institutes of Health Tissue Plasminogen Activator Pilot
Study. Significantly increased use of 911 was the likely major explanation
for the shortened arrival times. The decrease in arrival times may be a
consequence of the public and professional education programs conducted at
all study sites.
ARTICLES
Urgent therapy for acute stroke. Effects of a stroke trial on untreated patients
Section of Emergency Medicine, University of Michigan, Ann Arbor.
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