Rapid Response to Stroke Symptoms: The Delay in Accessing Stroke Healthcare (DASH) Study |
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Authors: | Wayne D Rosamond PhD Rebecca A Gorton BS Albert R Hinn MD Susan M Hohenhaus RN Dexter L Morris PhD MD |
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Institution: | University of North Carolina, Chapel Hill, NC, School of Public Health, Department of Epidemiology;School of Medicine, Departments of Emergency Medicine;School of Medicine, Departments of Neurology |
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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 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. |
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Keywords: | cerebral infarction emergency medicine epidemiology symptomatology stroke access to care |
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