Concordance of stroke symptom onset time: The second delay in accessing stroke healthcare (DASH II) study

PURPOSE: This study examines the concordance between symptom onset obtained during an interview in the emergency department (ED) compared to that reco rded in the medical record among patients with stroke-like symptoms and cha racterizes the frequency of missing symptom onset information in the medica l record. METHODS: Interviews with patients presenting with signs and symptoms of acu te stroke were completed in the ED of seven hospitals to determine symptom onset time. Symptom onset recorded in the medical record was abstracted aft er the patient was discharged. RESULTS: Among the patients who presented to the ED with stroke-like sympto ms, 60.2% overall (n = 583) and 61.9% among stroke patients (n = 252) had a symptom onset date and time recorded in the medical record. The Pearson co rrelation of prehospital delay time, comparing symptom onset obtained by in terview to that obtained by the medical record was 0.80 and among stroke pa tients was 0.91. Concordance of prehospital delay time for stroke within +/ - 1 h between the interview and the medical record was 60.1%. For stroke pa tients, concordance was more likely for those who had higher functional sta tus prior to the acute episode. CONCLUSIONS: Symptom onset time was often missing from the medical record. Standardized and systematic recording of delay time in the medical record c ould increase its utility as a clinical measure and as a research tool for acute stroke. Ann Epidemiol 2001;11:202-207. (C) 2001 Elsevier Science Inc. All rights reserved.