A community stroke study: Factors influencing stroke awareness and hospital arrival time

Background: One reason patients do not receive thrombolytic therapy for the treatment of stroke is late arrival to the emergency department (ED). One factor could be due to lack of awareness of stroke symptoms. We tested our hypothesis at 2 hospitals in central Illinois. Objective: To determine hospital arrival times and the level of stroke awareness in an urban/rural setting. Methods: Data were collected from transient ischemic attack (TIA)/stroke patients over a 6-month period. Patients were asked if they knew they were having a stroke, time from symptom onset to hospital arrival, and how they arrived at the hospital. Patient medical records were reviewed to determine risk factor data and classify stroke subtype using the Trial of ORG-10172 in Acute Stroke Treatment (TOAST) criteria. Results: Data were obtained from 185 patients. Only 33% of patients arrived at the hospital within 2 hours of symptom onset. Predictors for early arrival were identified as perceived awareness of having a stroke (odds ratio [OR] = 2.13, 95% confidence interval [CI], 1.01-4.46), calling 911 (OR = 3.40, 95% CI, 1.70-6.82), and TIA (OR = 3.57, 95% CI, 1.50-8.61). Twenty-six percent of the patients were aware they were having a stroke. Diagnosis of a TIA was identified as a predictor of stroke awareness (OR = 2.46, 95% CI, 1.01-5.96). Patients who did not have any stroke risk factors were more aware of having a stroke compared with patients who had documented risk factors (OR = 3.33, 95% CI, 1.09-10.0). Conclusions: Results from this study indicate a lack of public knowledge regarding stroke symptoms in this urban/rural community.