FACTORS ASSOCIATED WITH EARLY PRESENTATION OF ACUTE STROKE

Background and Purpose: Patients with stroke symptoms commonly delay m any hours before seeking medical attention. We sought to explore the f actors associated with early presentation of stroke patients to physic ians. Methods: We prospectively studied 100 consecutive acute stroke p atients presenting to three large, urban medical centers. Using a stan dardized, structured interview and chart review, we assessed patient e ducation about stroke, risk factors, clinical features of the stroke, source of stroke recognition, and timing of presentation. We did not s tudy the distance from the site of stroke onset to the site of physici an contact. Results: Stroke onset time was known in 96 of the patients . Mean patient age was 71.3 years, 79% had at least one stroke risk fa ctor, 26% had prior transient ischemic attack, 19% had prior stroke, 7 4% had some high school education, and 86% had regular physicians. Onl y 8% had been previously educated about stroke symptoms. Eighty one pe rcent of strokes were ischemic. The mean time to physician contact was 13.4+/-2.3 hours (median, 4.0 hours) and to neurologist contact was 2 1.2+/-2.9 hours. A skewed distribution of presentation times accounts for the mean-median differences. A small number of patients presenting very late could have an effect on the correlations between presentati on time and the variables studied. Early presentation time was associa ted with increased age, the sudden onset of a stable deficit, and reco gnition that the symptoms signified stroke. Only the sudden onset of a stable deficit correlated independently with early presentation time (P=.0048). There was no correlation between presentation time and prio r transient ischemic attack or stroke, headache, vomiting, loss of con sciousness or seizures at onset, or stroke subtype, but a type II erro r could not be excluded. Conclusions: Despite their education level, r egular health care, and risk factors, especially prior stroke and tran sient ischemic attack, these patients were not knowledgeable about str oke and delayed many hours before contacting physicians. The course of symptoms and recognition that they signified stroke were associated w ith earlier presentation. Patient education focused on groups at risk may hasten the presentation and treatment of acute stroke.