Prehospital and emergency department delays after acute stroke - The Genentech Stroke Presentation Survey

Background and Purpose-Patient delays in seeking treatment for stroke and d elays within the Emergency Department (ED) are major factors in the lack of use of thrombolytic therapy for stroke. The Genentech Stroke Presentation Survey was a multicentered prospective registry of patients with acute stro ke. The study was designed to characterize prehospital delays and delays wi thin the ED. Methods-Patients with stroke symptoms presenting to 48 EDs participating in a clinical trial of acute stroke therapy were enrolled prospectively. A I- page data form was completed from patient interviews and medical records. Results-A total of 1207 subjects were entered into the study. Ninety-four p ercent of the 721 subjects with complete data had a diagnosis of stroke or transient ischemic attack, 13% were black, 50% were female, and 67% were ag ed > 65 years. The median time from symptom onset to ED arrival was 2.6 (in terquartile range 1.2 to 6.3) hours. The median time from ED arrival until CT scan completion was 1.1 (0.7 to 1.8) hours, and the total delay time (sy mptom onset until CT scan completion) had a median of 4.0 (2.3 to 8.3) hour s. Patients who arrived by emergency medical services had significantly sho rter prehospital delay times and times to CT scan. Age, race, sex, and educ ational level did not appear to affect prehospital delay times. Conclusions-Despite its limitations, this large geographically diverse stud y strongly suggests that the use of emergency medical services is an import ant modifiable determinant of delay time for the treatment of acute stroke.