Rapid Response to Stroke Symptoms: The Delay in Accessing Stroke Healthcare (DASH) Study

Abstract

Objective:To assess the determinants of prehospital delay for patients with presumed acute cerebral ischemia (ACI) in order to provide the background necessary to develop interventions to shorten such delays. Methods: A prospective registry of patients presenting to the ED with signs and symptoms of stroke was established at a university hospital from July 1995 to March 1996. Trained nurses performed a structured ED interview, which assessed prehospital delay and potential confounders. Results: The median delay (interquartile range) from symptom onset to ED arrival for all patients seeking care for stroke-like symptoms (n = 152) was 3.0 hours (1.5-7.8 hr). The median delay from symptom onset to ED arrival was less in cases where a witness first recognized that there was a serious problem than it was when the patient first identified the problem. A heightened sense of urgency by the patient about his or her symptoms, and use of 91 ]/emergency medical services (EMS) transport were also associated with rapid arrival in the ED within 3 hours of symptom onset. After adjusting for all predictor variables in a multivariable logistic regression model, only recognition of symptoms by a witness and calling 9 1 1EMS transport remained statistically significant. Conclusions: These data suggest that future efforts to intervene on prolonged prehospital delay for patients with ACI should include strategies for the community as a whole as well as persons at risk for stroke and should reinforce the use of 91 1 and EMS transport.

Emergency Medicine Resident Work Productivity in an Academic Emergency Department

“…[4][5][6] The reasons for this prolonged delay are not well understood. [7][8][9] Several factors have been found to be associated with shorter delays from symptom onset to hospital arrival (out-of-hospital delay), including the presence of a bystander, 10 8,13,14 and the presence of symptoms on awakening. 13 Whether individuals with acute stroke view their symptoms as signaling a stroke may also impact care-seeking behavior.…”

“…The methods used in this prospective registry of patients presenting to the ED with signs or symptoms of stroke have been previously reported. 10 The institutional review board on human subjects in research at the University of North Carolina at Chapel Hill approved the study protocol, and patients or next-of-kin gave informed consent to be interviewed.…”

Stroke Symptom Attribution and Time to Emergency Department Arrival: The Delay in Accessing Stroke Healthcare Study

“…[4][5][6] The reasons for this prolonged delay are not well understood. [7][8][9] Several factors have been found to be associated with shorter delays from symptom onset to hospital arrival (out-of-hospital delay), including the presence of a bystander, 10 calling 911, 5,[9][10][11] stroke subtype, 4,8 sudden onset of symptoms, 7 stroke severity, [5][6][7][8][9][10][11][12] time of day, 8,13,14 and the presence of symptoms on awakening. 13 Whether individuals with acute stroke view their symptoms as signaling a stroke may also impact care-seeking behavior.…”

The future of geriatrics: a public health perspective

“…However, other groups have continued to suffer from the tyranny of single organ care, notably the 'incurables', young chronically sick people and those who were not capable of 'getting better' immediately. The lack of good, consistent postmyocardial infarction advice, despite excellent research findings, 1,2 and a lack of rapid admission 3,4 and full rehabilitation services 5 for stroke victims remain a matter for concern in general medicine. How will new changes in the NHS, especially the development of Primary Care Groups (PCGs) and Trusts affect geriatrics?…”