Understanding the seriousness of a stroke is essential for appropriate help-seeking and early arrival at a stroke centre: A cross-sectional study of stroke patients and their bystanders

Abstract

Introduction Only a minority of patients with acute ischaemic stroke receive reperfusion treatment, primarily due to prehospital delay. We aimed to investigate predictors of a primary contact to the emergency medical services, arrival at stroke centre within 3 h of symptom onset and initiation of reperfusion therapy in patients with acute stroke. Patients and methods We conducted a cross-sectional study of consecutive patients with acute ischaemic stroke, intracerebral haemorrhage or transient ischaemic attack. Structured interviews of patients and bystanders were performed and combined with clinical information from the Danish Stroke Registry. Eligible patients were aged ≥18 years and were independent in activities of daily living before the stroke. Results We included 435 patients. Presence of a bystander at symptom onset and knowledge of ≥2 core symptoms of stroke were associated with a primary emergency medical services contact. Higher stroke severity and patients or bystanders perceiving the situation as very serious were associated with a primary emergency medical services contact (ORpatients 2.10; 95% CI 1.12–3.95 and ORbystanders 22.60; 95% CI 4.98–102.67), <3 h from onset to arrival (ORpatients 3.01; 95% CI 1.46–6.21 and ORbystanders 4.44; 95% CI 1.37–14.39) and initiation of reperfusion therapy (ORpatients 3.08; 95% CI 1.23–7.75 and ORbystanders 4.70; 95% CI 1.14–19.5). Conclusion: Having a bystander, knowledge of ≥2 core symptoms and understanding that stroke is a serious event are associated with appropriate help-seeking behaviour, shorter prehospital delay and higher chance of reperfusion therapy in acute stroke patients.

Help‐seeking behaviour and subsequent patient and system delays in stroke

“…The interviews were performed at the stroke unit shortly after admission (median: 1 day) to minimize the risk of recall bias. Interviewing bystanders has given additional insight into the delay as patients more often seem to misinterpret the situation and ignore the severity of the symptoms 13 . We included information on stroke localization to evaluate the association with prehospital delay.…”

“…Patients with transient ischaemic attack (TIA) were excluded because these patients do not always need urgent transportation to a stroke centre (see Figure 1 for a complete list of exclusion criteria). The same study population, including TIA patients, was used in a previous paper 13 …”

“…Some of the bystanders could not be reached, did not wish to participate or had other reasons for not participating. The interview has been described in detail elsewhere 13 …”

“…Symptoms of stroke may be ignored or not recognized as signs of a stroke. Moreover, some patients may be unable to seek help unless they have a bystander 5,7,13 …”

“…Existing guidelines recommend that the Emergency Medical Services (EMS) should be contacted immediately if a person experiences symptoms of a stroke, as this ensures the fastest transfer to the nearest stroke centre for evaluation and acute treatment 6,7,18 . However, in up to 50% of the stroke patients, the first contact is directed to general practice (GP), out‐of‐hours primary care (OOH‐PC) or other healthcare professionals 8,13,17,19 …”