URGENT THERAPY FOR ACUTE STROKE - EFFECTS OF A STROKE TRIAL ON UNTREATED PATIENTS

Background and Purpose As part of the recruitment efforts for the Nati onal Institutes of Health Tissue Plasminogen Activator Pilot Study, pu blic education and awareness campaigns were conducted to encourage ear ly hospital arrival. We evaluated the change in arrival times during t he course of the study for all stroke patients, including those who we re not entered into study. Methods Data were gathered on all patients presenting within 24 hours of stroke onset to all of the study hospita ls. Coincident with the start of the study, educational and promotiona l programs, which stressed signs and symptoms of stroke and the need t o call 911, were presented to physicians, paramedical personnel, and t he public. The study was divided into four quartiles to analyze differ ences in time to hospital arrival and use of 911. Results Of 2099 pati ents screened, time data were available on 1116. During the course of the study, the mean time from symptom onset to hospital arrival declin ed significantly (3.2 hours versus 1.5 hours). Patients arrived for tr eatment sooner at community hospitals than at university/teaching hosp itals. The use of 911 increased from 39% in the first quartile of the study to 60% in the fourth quartile. This was a consistent finding in all study sites. Increased use of 911 was seen almost exclusively in p atients with nonhemorrhagic stroke. Conclusions Times from stroke onse t to hospital arrival decreased significantly during the course of the National Institutes of Health Tissue Plasminogen Activator Pilot Stud y. Significantly increased use of 911 was the likely major explanation for the shortened arrival times. The decrease in arrival times may be a consequence of the public and professional education programs condu cted at all study sites.