Objective: Timely evaluation and initiation of treatment is the key for improving stroke outcomes, although minimizing the time from symptom onset to the first contact with healthcare professionals remains a challenge. We aimed to identify patient-related factors associated with early hospital arrival. Materials and methods:In this cross-sectional survey, we included patients with stroke or transient ischemic attack admitted directly to one of two noncomprehensive stroke units or transferred to the units from comprehensive stroke centers in the Capital Region of Denmark. Patient-reported factors associated with early hospital arrival were analyzed using multivariable logistic regression analysis adjusted for age, sex, education, living arrangement, brain location of the stroke, stroke severity, patientperceived symptom severity, history of prior stroke, stroke risk factors, and knowledge of stroke symptoms. Results:In total, 479 patients with acute stroke were included (median age 74 (25th-75th percentile, 64-80), 40% women), of whom 46.4% arrived within 180 min of symptom onset. Factors associated with early hospital arrival were patients or bystanders choosing emergency medical service (EMS) for the first contact with a medical professional (adjusted odds ratio (OR), 3.41; 95% confidence interval, CI [1.57, 7.35]) or the patient's perceived symptom severity above the median score of 25 on a 100-point verbal scale (adjusted OR, 2.44; 95% CI [1.57, 3.82]). Living alone reduced the likelihood of early arrival (adjusted OR, 0.53; 95% CI [0.33, 0.86]). Conclusions:Only when patients perceived symptoms as severe or when EMS was selected as the first contact, early arrival for stroke treatment was ensured.
BACKGROUND: Approximately 50% of Danish stroke patients did not arrive within the 4.5-hour revascularization window in 2018, and only 20% received acute revascularization therapy. Delay in seeking help was a major factor for missing the time window. This study explored patient-reported factors influencing the timing of a decision to seek help. METHODS: We performed a qualitative interview study to explore prehospital help-seeking behavior. Inclusion was guided by a purposive sampling of stroke and transient ischemic attack patients and, if necessary, bystanders. Semistructured explorative interviews with 8 patients and 2 bystanders were audio-recorded, transcribed verbatim, and analyzed via thematic analysis. RESULTS: Analysis yielded 3 main themes: (1) symptom interpretation, (2) barriers and enablers to response, and (3) participant suggested optimization of acute stroke response and awareness. DISCUSSION: Factors associated with prompt action to seek help were either a perception that the symptom indicated a serious illness or a strong emotional response. Patients with recurrent stroke failed to associate symptoms with a new stroke. Having a stroke in unfamiliar surroundings prompted delay in seeking help. Suggestions for optimization included targeted stroke campaigns. CONCLUSION: Response to stroke onset may be driven by perceptions of symptom severity and emotional response rather than the ability to correctly identify symptoms. Stroke education should include the information that new stroke symptoms may be different from the old ones because different parts of the brain may be affected.
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