Delay in presentation and evaluation for acute stroke - Stroke time registry for outcomes knowledge and epidemiology (STROKE)

Background and Purpose-Early treatment is a critical determinant of success ful intervention in acute stroke. The study was designed to find current pa tterns of stroke care by determining delays in time from onset of signs or symptoms to arrival at the emergency department and to initial evaluation b y physicians and by identifying factors associated with these delays. Methods-Data were prospectively collected by nurses and physicians from pat ients, patients' family members, and medical records from 10 hospitals of t he Robert Wood Johnson Health System in New Jersey. Results-A total of 553 patients who presented with signs or symptoms of acu te stroke were studied. Thirty-two percent of patients arrived at the emerg ency department within 1.5 hours of stroke onset. Forty-six percent of pati ents arrived within 3 hours and 61% within 6 hours. Delays in arrival time were significantly associated with sex, race, transportation mode, and hist ory of cardiovascular disease. Patients arriving by ambulance were more lik ely to present earlier (odds ratio [OR] 3.7 for arrival within 3 hours; OR 4.5 for arrival within 6 hours). Patients arriving by ambulance (OR 2.3 wit hin 15 minutes; OR 1.7 within 30 minutes) and those requiring admission to intensive care units (OR 4.5 within 15 minutes and OR 5.2 within 30 minutes ) were examined sooner by physicians. Conclusions-Despite national efforts to promote prompt stroke evaluation an d treatment, significant delays still exist. The lack of improvement throug hout the past decade underscores the need for implementation of effective p ublic health programs designed to minimize the time to evaluation and treat ment of stroke.