STROKE PATIENTS KNOWLEDGE OF STROKE - INFLUENCE ON TIME TO PRESENTATION

Background and Purpose New treatments for acute stroke will likely hav e to be given soon after stroke onset. Little is known about stroke pa tients' general knowledge about stroke, their interpretation of stroke symptoms, and how these factors influence the timing of their decisio n to seek medical attention. Methods We interviewed consecutive stroke patients within 72 hours of stroke onset to define factors influencin g time of arrival to the emergency department. Data recorded included demographic information, method of transportation, type of stroke symp toms, the patient's interpretation of the symptoms, previous stroke, a nd knowledge of stroke warning signs. Stroke severity was measured wit h the Barthel Index. Early arrival was defined as within 3 hours of aw areness of symptoms. Results Sixty-seven patients were interviewed; 96 % had an ischemic stroke and 4% a cerebral hemorrhage. Although 38% of patients professed to know the warning signs of stroke, only 25% corr ectly interpreted their symptoms. Patients with prior stroke were more likely to correctly interpret their symptoms (45% versus 16%; P=.03) but were not more likely to present early (19% versus 39%; P=.35). Eig hty-six percent of patients presenting more than 3 hours after stroke onset thought that their symptoms were not serious. The 24% (n=16) of early arrivals were more likely to arrive by ambulance (81% versus 38% ; P=.003) and had more severe strokes (Barthel Index score of 49 versu s 72; P=.01) than late arrivals. Arrival by ambulance was independentl y associated with early arrival (odds ratio, 5.55; 95% confidence inte rval, 1.37 to 22.6). Conclusions Approximately one quarter of stroke p atients correctly interpret their symptoms as representing a stroke. T his knowledge is not associated with early presentation to the emergen cy department. Ambulance transport is independently associated with ea rly arrival at the emergency department. Even when patients know that they are having a stroke, most present late because they perceive thei r symptoms as ''not serious.'' Widespread public education of stroke-p rone individuals may increase the proportion of patients eligible for new acute stroke treatments.