(Stroke. 1997;28:912-915.)
© 1997 American Heart Association, Inc.
Articles |
Stroke Patients' Knowledge of Stroke
Influence on Time to Presentation
From the Department of Neurology, Indiana University School of Medicine (L.S.W., A.B.); Indiana University School of Medicine (D.R.); and Regenstrief Institute for Health Care (D.J.M.), Indianapolis, Ind.
Correspondence to Linda S. Williams, MD, Department of Neurology, Indiana University School of Medicine, 541 Clinical Dr, CL 365, Indianapolis, IN 46202. E-mail lindaw{at}medwish.dmed.iupui.edu
Background and Purpose New treatments for acute stroke will likely have to be given soon after stroke onset. Little is known about stroke patients' general knowledge about stroke, their interpretation of stroke symptoms, and how these factors influence the timing of their decision to seek medical attention.
Methods We interviewed consecutive stroke patients within 72 hours of stroke onset to define factors influencing time of arrival to the emergency department. Data recorded included demographic information, method of transportation, type of stroke symptoms, the patient's interpretation of the symptoms, previous stroke, and knowledge of stroke warning signs. Stroke severity was measured with the Barthel Index. Early arrival was defined as within 3 hours of awareness of symptoms.
Results Sixty-seven patients were interviewed; 96% had an ischemic stroke and 4% a cerebral hemorrhage. Although 38% of patients professed to know the warning signs of stroke, only 25% correctly interpreted their symptoms. Patients with prior stroke were more likely to correctly interpret their symptoms (45% versus 16%; P=.03) but were not more likely to present early (19% versus 39%; P=.35). Eighty-six percent of patients presenting more than 3 hours after stroke onset thought that their symptoms were not serious. The 24% (n=16) of early arrivals were more likely to arrive by ambulance (81% versus 38%; P=.003) and had more severe strokes (Barthel Index score of 49 versus 72; P=.01) than late arrivals. Arrival by ambulance was independently associated with early arrival (odds ratio, 5.55; 95% confidence interval, 1.37 to 22.6).
Conclusions Approximately one quarter of stroke patients correctly interpret their symptoms as representing a stroke. This knowledge is not associated with early presentation to the emergency department. Ambulance transport is independently associated with early arrival at the emergency department. Even when patients know that they are having a stroke, most present late because they perceive their symptoms as "not serious." Widespread public education of stroke-prone individuals may increase the proportion of patients eligible for new acute stroke treatments.
Key Words: health education • stroke, acute • stroke onset
This article has been cited by other articles:
 |
|
 |
|
  E. Touze, J. Coste, M. Voicu, J. Kansao, R. Masmoudi, B. Doumenc, P. Durieux, and J.-L. Mas Importance of In-Hospital Initiation of Therapies and Therapeutic Inertia in Secondary Stroke Prevention: IMplementation of Prevention After a Cerebrovascular evenT (IMPACT) Study Stroke, June 1, 2008; 39(6): 1834 - 1843. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Mikulik, L. Bunt, D. Hrdlicka, L. Dusek, D. Vaclavik, and J. Kryza Calling 911 in Response to Stroke: A Nationwide Study Assessing Definitive Individual Behavior Stroke, June 1, 2008; 39(6): 1844 - 1849. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Sacchetti, M. T. Di Mascio, G. Pelone, V. Gallo, and M. Prencipe Targeting Stroke Awareness Public Campaigns Stroke, February 1, 2008; 39(2): e50 - e50. [Full Text] [PDF]
|
|
|
|
|
|
A. W. Alexandrov Solving the Issue of Patient Arrival Time: A Call for Vigilant Action Stroke, August 1, 2007; 38(8): 2219 - 2220. [Full Text] [PDF]
|
|
|
|
|
|
C. Hodgson, P. Lindsay, and F. Rubini Can Mass Media Influence Emergency Department Visits for Stroke? Stroke, July 1, 2007; 38(7): 2115 - 2122. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. K. Moser, L. P. Kimble, M. J. Alberts, A. Alonzo, J. B. Croft, K. Dracup, K. R. Evenson, A. S. Go, M. M. Hand, R. U. Kothari, et al. Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke: A Scientific Statement From the American Heart Association Council on Cardiovascular Nursing and Stroke Council Circulation, July 11, 2006; 114(2): 168 - 182. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Z. Bambauer, S. C. Johnston, D. E. Bambauer, and J. A. Zivin Reasons why few patients with acute stroke receive tissue plasminogen activator. Arch Neurol, May 1, 2006; 63(5): 661 - 664. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Mandelzweig, U. Goldbourt, V. Boyko, and D. Tanne Perceptual, Social, and Behavioral Factors Associated With Delays in Seeking Medical Care in Patients With Symptoms of Acute Stroke Stroke, May 1, 2006; 37(5): 1248 - 1253. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Agyeman, K. Nedeltchev, M. Arnold, U. Fischer, L. Remonda, J. Isenegger, G. Schroth, and H. P. Mattle Time to Admission in Acute Ischemic Stroke and Transient Ischemic Attack Stroke, April 1, 2006; 37(4): 963 - 966. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Z. Deng, M. J. Reeves, B. S. Jacobs, G. L. Birbeck, R. U. Kothari, S. L. Hickenbottom, A. J. Mullard, S. Wehner, K. Maddox, A. Majid, et al. IV tissue plasminogen activator use in acute stroke: Experience from a statewide registry Neurology, February 14, 2006; 66(3): 306 - 312. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Di Legge, J. Fang, G. Saposnik, and V. Hachinski The impact of lesion side on acute stroke treatment Neurology, July 12, 2005; 65(1): 81 - 86. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Billings-Gagliardi and K. M. Mazor Development and Validation of the Stroke Action Test Stroke, May 1, 2005; 36(5): 1035 - 1039. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Task Force Members, L. H. Schwamm, A. Pancioli, J. E. Acker III, L. B. Goldstein, R. D. Zorowitz, T. J. Shephard, P. Moyer, M. Gorman, S. C. Johnston, et al. Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems Stroke, March 1, 2005; 36(3): 690 - 703. [Full Text] [PDF]
|
|
|
|
|
|
L. H. Schwamm, A. Pancioli, J. E. Acker III, L. B. Goldstein, R. D. Zorowitz, T. J. Shephard, P. Moyer, M. Gorman, S. C. Johnston, P. W. Duncan, et al. Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems Circulation, March 1, 2005; 111(8): 1078 - 1091. [Full Text] [PDF]
|
|
|
|
|
|
California Acute Stroke Pilot Registry (CASPR) Inv Prioritizing interventions to improve rates of thrombolysis for ischemic stroke Neurology, February 22, 2005; 64(4): 654 - 659. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. J Morgan, R. Chambers, J. Banerji, J. Gater, and J. Jordan Consumers leading public consultation: the general public's knowledge of stroke Fam. Pract., February 1, 2005; 22(1): 8 - 14. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Ovbiagele, J. L. Saver, A. Fredieu, S. Suzuki, N. McNair, A. Dandekar, T. Razinia, and C. S. Kidwell PROTECT: A coordinated stroke treatment program to prevent recurrent thromboembolic events Neurology, October 12, 2004; 63(7): 1217 - 1222. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Carroll, J Hobart, C Fox, L Teare, and J Gibson Stroke in Devon: knowledge was good, but action was poor J. Neurol. Neurosurg. Psychiatry, April 1, 2004; 75(4): 567 - 571. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K.-C. Chang, M.-C. Tseng, and T.-Y. Tan Prehospital Delay After Acute Stroke in Kaohsiung, Taiwan Stroke, March 1, 2004; 35(3): 700 - 704. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Camilo and L. B. Goldstein Statewide Assessment of Hospital-Based Stroke Prevention and Treatment Services in North Carolina: Changes Over the Last 5 Years Stroke, December 1, 2003; 34(12): 2945 - 2950. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. L. Silver, F. Rubini, D. Black, and C. S. Hodgson Advertising Strategies to Increase Public Knowledge of the Warning Signs of Stroke Stroke, August 1, 2003; 34(8): 1965 - 1968. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein Editorial Comment--Advertising Strategies to Increase the Public Knowledge of the Warning Signs of Stroke Stroke, August 1, 2003; 34(8): 1968 - 1969. [Full Text] [PDF]
|
|
|
|
|
|
M. Fisher Recommendations for Advancing Development of Acute Stroke Therapies: Stroke Therapy Academic Industry Roundtable 3 Stroke, June 1, 2003; 34(6): 1539 - 1546. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. C. Johnston, P. B. Fayad, P. B. Gorelick, D. F. Hanley, P. Shwayder, D. van Husen, and T. Weiskopf Prevalence and knowledge of transient ischemic attack among US adults Neurology, May 13, 2003; 60(9): 1429 - 1434. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Handschu, R. Poppe, J. Rauss, B. Neundorfer, and F. Erbguth Emergency Calls in Acute Stroke Stroke, April 1, 2003; 34(4): 1005 - 1009. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. T. Schneider, A. M. Pancioli, J. C. Khoury, E. Rademacher, A. Tuchfarber, R. Miller, D. Woo, B. Kissela, and J. P. Broderick Trends in Community Knowledge of the Warning Signs and Risk Factors for Stroke JAMA, January 15, 2003; 289(3): 343 - 346. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Reeves, J. G. Hogan, and A. P. Rafferty Knowledge of stroke risk factors and warning signs among Michigan adults Neurology, November 26, 2002; 59(10): 1547 - 1552. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Gupta, P. Thomas, D R Collins, P M E McCormack, and D O'Neill General perception of stroke BMJ, August 17, 2002; 325(7360): 392 - 392. [Full Text]
|
|
|
|
|
|
L. Derex, P. Adeleine, N. Nighoghossian, J. Honnorat, and P. Trouillas Factors Influencing Early Admission in a French Stroke Unit Stroke, January 1, 2002; 33(1): 153 - 159. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Sug Yoon, R. F. Heller, C. Levi, J. Wiggers, and P. E. Fitzgerald Knowledge of Stroke Risk Factors, Warning Symptoms, and Treatment Among an Australian Urban Population Stroke, August 1, 2001; 32(8): 1926 - 1930. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. R. Evenson, D. L. Morris, W. D. Rosamond, J. H. Brice, S. L. Huston, and E. M. Puckett Addressing Healthy People 2010 Objectives for Stroke Stroke, July 1, 2001; 32(7): 1692 - 1692. [Full Text] [PDF]
|
|
|
|
|
|
B. Kissela, J. Broderick, D. Woo, R. Kothari, R. Miller, J. Khoury, T. Brott, A. Pancioli, E. Jauch, J. Gebel, et al. Greater Cincinnati/Northern Kentucky Stroke Study : Volume of First-Ever Ischemic Stroke Among Blacks in a Population-Based Study Editorial Comment : The Greater Cincinnati/Northern Kentucky Stroke Study: Volume of First-Ever Ischemic Stroke Among Black Americans in a Population-Based Study Stroke, June 1, 2001; 32(6): 1285 - 1290. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. R. Lacy, D.-C. Suh, M. Bueno, and J. B. Kostis Delay in Presentation and Evaluation for Acute Stroke : Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.) Stroke, January 1, 2001; 32(1): 63 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Morris, W. Rosamond, K. Madden, C. Schultz, and S. Hamilton Prehospital and Emergency Department Delays After Acute Stroke : The Genentech Stroke Presentation Survey Stroke, November 1, 2000; 31(11): 2585 - 2590. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. B. Schroeder, W. D. Rosamond, D. L. Morris, K. R. Evenson, and A. R. Hinn Determinants of Use of Emergency Medical Services in a Population With Stroke Symptoms : The Second Delay in Accessing Stroke Healthcare (DASH II) Study Stroke, November 1, 2000; 31(11): 2591 - 2596. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. B. Goldstein, J. Bian, G. P. Samsa, A. J. Bonito, L. J. Lux, and D. B. Matchar New Transient Ischemic Attack and Stroke: Outpatient Management by Primary Care Physicians Arch Intern Med, October 23, 2000; 160(19): 2941 - 2946. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. H. Wein, L. Staub, R. Felberg, S. L. Hickenbottom, W. Chan, J. C. Grotta, A. M. Demchuk, J. Groff, L. K. Bartholomew, and L. B. Morgenstern Activation of Emergency Medical Services for Acute Stroke in a Nonurban Population : The T.L.L. Temple Foundation Stroke Project Stroke, August 1, 2000; 31(8): 1925 - 1928. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. M. Weltermann, J. Homann, A. Rogalewski, S. Brach, S. Voss, and E. B. Ringelstein Stroke Knowledge Among Stroke Support Group Members Stroke, June 1, 2000; 31(6): 1230 - 1233. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. B. Stern, M. Berman, J. J. Thomas, and A. C. Klassen Community Education for Stroke Awareness : An Efficacy Study Stroke, April 1, 1999; 30(4): 720 - 723. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein and C. E. Hulsebosch Amphetamine-Facilitated Poststroke Recovery • Response Stroke, March 1, 1999; 30(3): 696 - 698. [Full Text] [PDF]
|
|
|
|
|
|
S. R. Levine and M. Gorman "Telestroke" : The Application of Telemedicine for Stroke Stroke, February 1, 1999; 30(2): 464 - 469. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Wester, J. Radberg, B. Lundgren, and M. Peltonen Factors Associated With Delayed Admission to Hospital and In-Hospital Delays> in Acute Stroke and TIA : A Prospective, Multicenter Study Stroke, January 1, 1999; 30(1): 40 - 48. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. P. Stroemer, T. A. Kent, C. E. Hulsebosch, and D. M. Feeney Enhanced Neocortical Neural Sprouting, Synaptogenesis, and Behavioral Recovery With D-Amphetamine Therapy After Neocortical Infarction in Rats • Editorial Comment Stroke, November 1, 1998; 29(11): 2381 - 2395. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Pancioli, J. Broderick, R. Kothari, T. Brott, A. Tuchfarber, R. Miller, J. Khoury, and E. Jauch Public Perception of Stroke Warning Signs and Knowledge of Potential Risk Factors JAMA, April 22, 1998; 279(16): 1288 - 1292. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. B. Fontanarosa and M. A. Winker Timely and Appropriate Treatment of Acute Stroke: What's Missing From This Picture? JAMA, April 22, 1998; 279(16): 1307 - 1309. [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr Treating Ischemic Stroke as an Emergency Arch Neurol, April 1, 1998; 55(4): 457 - 461. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Kothari, L. Sauerbeck, E. Jauch, J. Broderick, T. Brott, J. Khoury, and T. Liu Patients' Awareness of Stroke Signs, Symptoms, and Risk Factors Stroke, October 1, 1997; 28(10): 1871 - 1875. [Abstract] [Full Text]
|
|