Patient delay in TIA: a systematic review

Abstract

Background Patients who suffer a transient ischemic attack (TIA) have a high short-term risk of developing ischemic stroke, notably within the first 48 h. Timely diagnosis and urgent preventive treatment substantially reduce this risk. We conducted a systemic review to quantify patient delay in patients with (suspected) TIA, and assess determinants related to such delay. Methods A systematic review using MEDLINE and EMBASE databases up to March 2017 to identify studies reporting the time from onset of TIA symptoms to seeking medical help. Results We identified nine studies providing data on patient delay, published between 2006 and 2016, with 7/9 studies originating from the United Kingdom (UK). In total 1103 time-defined TIA patients (no remaining symptoms > 24 h), and 896 patients with a minor stroke (i.e., mild remaining symptoms > 24 h) were included (49.1% men, mean age 72.2 years). Patient's delay of more than 24 h was reported in 33.1-44.4% of TIA patients, with comparable proportions for minor stroke patients. Delays were on average shorter in patients interviewed at the emergency department than among patients seen at TIA outpatient clinics. Univariably associated with a shorter delay were (1) a longer duration of symptoms, (2) motor symptoms, (3) a higher ABCD2 score, and (4) correct patient's recognition as possible ischemic cerebrovascular event. Conclusions More than a third of patients experiencing a TIA delays medical attention for more than a day, thus critically extending the initiation of stroke preventive treatment. There still seems to be insufficient awareness among lay people that symptoms suggestive of TIA should be considered as an emergency. Additional data and multivariable analyses are needed to define main determinants of patient delay.

Delays in Presentation Time Under the COVID-19 Epidemic in Patients With Transient Ischemic Attack and Mild Stroke: A Retrospective Study of Three Hospitals in a Japanese Prefecture

“…Previous studies suggest that reluctance to seek medical attention shortly after symptom onset during the COVID-19 pandemic was related to the restrictions in healthcare systems as well as a decreased awareness/shift of attention of the patients, the desire not to overload the emergency healthcare systems, or the fear of in-hospital infection (28). Delays in seeking medical attention after TIA/mild stroke were reported by several studies even before the COVID-19 pandemic (29)(30)(31)(32). In addition to the symptoms themselves, the perception and response of patients and people around them, and the referral process contributed to the pre-hospital delay.…”

Early vascular imaging and key system strategies expedite carotid revascularization after transient ischemic attack and stroke

“…This finding is consistent with a recent systematic review that noted 40% of patients with a TIA delay seeking medical attention for more than 24 hours. 19 Public awareness and, more important, public action through emergency presentation when TIA/stroke symptoms take place requires further attention and exploration of effective interventions. Although public awareness campaigns of common stroke symptoms such as FAST (Fefacial weakness, Aearm weakness, Sespeech difficulty, Tetime to call 911) have demonstrated improvements in public knowledge, the impact on patient response to stroke symptoms has been modest.…”

Family Perception of Diseases Related to the Reference Time in Stroke Patient: Literature Review

“…However, the effect on patient response is limited, and it is therefore emphasized that future campaigns should strengthen response to stroke symptoms; the need to respond promptly and contact a health care professional. Lay people need to be better informed about the risk of early stroke and the need for emergency calls after TIA, also when symptoms are brief (Dolmans, 2019).…”