Lack of Association Between Stroke Symptom Knowledge and Intent to Call 911

Abstract

Background and Purpose-Excessive prehospital delay between acute stroke onset and hospital arrival is an ongoing problem. Translating knowledge of stroke warning signs into appropriate action is critical to decrease prehospital delay. Our objectives were to estimate the proportion of Michigan adults who would react appropriately by calling 911 when presented with hypothetical stroke-related scenarios and to examine the association between knowledge of warning signs and calling 911. Methods-In 2004, questions regarding initial response to health-related scenarios were added to the Michigan Behavioral Risk Factor Survey, a population-based telephone survey of adults. We calculated the proportion of respondents who would call 911 in response to 3 stroke-related scenarios and examined the association between stroke warning sign knowledge and 911 activation. Results-Among 4841 adults, 27.6% (95% CI, 26.2 to 29.0) had adequate knowledge of stroke warning signs (defined as reporting 3 correct warning signs), and 14.0% (95% CI, 12.9 to 15.1) reported they would call 911 for all 3 stroke-related scenarios. Knowledge of specific stroke warning signs was only modestly associated with calling 911 in response to medical scenarios that involved the same stroke symptom (OR, 1.17 to 1.39). Even among those with adequate knowledge of stroke warning signs, only 17.6% (95% CI, 15.5 to 20.0) would call 911 for all 3 stroke scenarios. Conclusions-In this population-based survey, stroke symptom knowledge was not associated with the intent to call 911 for stroke. This study emphasizes the critical role of motivation in addition to symptom knowledge to reducing delay time to hospital arrival for stroke. (Stroke. 2010;41:1501-1507.)

Awareness Of Stroke Risk Factors And Warning Signs And Attitude To Acute Stroke

“…Some authors have also showed that despite adequate knowledge of stroke warning signs and intention to immediately activate emergency medical service, in the real scenario a significant number of patients would fail activation of emergency medical service [35,65]. According to ESO only 33-50% of patients recognize their own symptoms as stroke, which might explain the discrepancies between theoretical intended behavior to acute stroke and the reaction in case of an acute stroke [23].…”

Delays in Seeking Care

“…Importantly, increased knowledge of stroke symptoms was not associated with the intent to call 911 for stroke. 4 Finally, patients may not be the only ones delaying care for women compared with men: one recent study showed that among young patients with MI, women were significantly more likely to experience a delay to reperfusion, 20 and other studies have found similar evidence of associations between sex and reperfusion delay as well. 21,22 Additionally, longer symptom-to-presentation time is independently associated with longer presentation-to-reperfusion time, suggesting that delays may beget delays in treatment for MI.…”

“…3 Knowledge of stroke warning symptoms seems to be similarly limited in both women and men, with 50% to 75% of individuals unaware of important warning symptoms for this condition. 4,5 Of course, women may also be somewhat more likely to experience atypical symptoms, such as nausea, shortness of breath, and back pain in the setting of ischemia, though data are mixed in terms of the degree to which this differs from men's symptom experience, [6][7][8][9] and women with myocardial infarction (MI) are more likely than men to present without chest pain. 10,11 This is particularly important because the absence of chest pain as a presenting symptom has been associated with increased mortality, especially among younger women with MI.…”

Stroke Treatment Academic Industry Roundtable (STAIR) Recommendations for Maximizing the Use of Intravenous Thrombolytics and Expanding Treatment Options With Intra-arterial and Neuroprotective Therapies

“…Knowledge can be increased with the use of mass media educational campaigns, but such knowledge is not necessarily associated with the intent to call for emergency assistance when symptoms occur. 8 Public education, however, is critical for increasing the demand for services. Additional social-behavioral research is needed to develop a strategy of public education that translates into appropriate action.…”