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 911/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 911/EMS 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 911 and EMS transport.
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 911/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 911/EMS 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 911 and EMS transport.
Authors: Lesli E Skolarus; Jillian B Murphy; Mackenzie Dome; Marc A Zimmerman; Sarah Bailey; Sophronia Fowlkes; Lewis B Morgenstern Journal: Health Promot Pract Date: 2014-11-03
Authors: Dawn Kleindorfer; Christopher J Lindsell; Charles J Moomaw; Kathleen Alwell; Daniel Woo; Matthew L Flaherty; Opeolu Adeoye; Tarek Zakaria; Joseph P Broderick; Brett M Kissela Journal: Am J Emerg Med Date: 2010-01-28 Impact factor: 2.469
Authors: Casey L Corches; A Camille McBride; Maria Cielito Robles; Narmeen Rehman; Sarah Bailey; Alina Oliver; Lesli E Skolarus Journal: Am J Health Behav Date: 2020-11-01