A systematic review of delays in seeking medical attention after transient ischaemic attack

Sprigg, Nikola; Machili, Chipulwa; Otter, Mary Edmunds; Wilson, Andrew; Robinson, Thompson G.

doi:10.1136/jnnp.2008.167924

Cited by 49 publications

(47 citation statements)

References 35 publications

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“…First, women in this community-based cohort arrive at the ED at the same speed as men, in contrast to the findings of two earlier studies. 22,25 Our data are in agreement with recent studies evaluating patients with TIA, 27,28 where no sex differences have been seen in ED arrival times. It is possible that more women are recognizing stroke as an emergency, and this may reflect a growing awareness of the importance of early treatment and the success of recent educational programs targeting high-risk women (e.g., the Go Red campaign spearheaded by the American Heart Association 29 ).…”

Section: Discussionsupporting

confidence: 92%

Emergency Department Arrival Times, Treatment, and Functional Recovery in Women with Acute Ischemic Stroke

Knauft

Chhabra

McCullough

2010

Journal of Women's Health

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Background: Sex disparities have been well documented in patients with ischemic stroke. Previous studies have suggested that female sex is a risk factor for delay in arrival time to the emergency department (ED) and may contribute to ineligibility for thrombolytic therapy. With the increase in education efforts targeting women, we investigated whether ED arrival times, rates of thrombolytic use, and functional outcomes continue to differ in men and women with acute ischemic stroke (AIS). Methods: This study was a retrospective database analysis of patients with AIS (2001AIS ( -2008. All AIS patients presenting within 24 hours with a known time of symptom onset and a documented admission National Institutes of Health Stroke Scale (NIHSS) were included. The Modified Barthel Index (MBI) assessed patients' functional status preadmission (historical), admission, and at 3 and 12 months poststroke. Results: Included in the analysis were 480 (50.6%) women and 468 (49.4%) men. Women were significantly older than men (70.6 AE 0.7 vs. 65.3 years AE 0.6, p 0.001). Mean onset-to-ED time was not significantly different between the sexes (women 265 AE 283 vs. men 245 AE 300 minutes), nor was prestroke MBI. Logistic regression analysis demonstrated that female sex, increasing age, higher admission NIHSS, and longer onset-to-ED times all contributed to poorer functional status. Conclusions: Women arrive at the ED at equivalent speed as men after AIS. Women had greater functional impairments at 3 months and 12 months poststroke despite equivalent prestroke MBI and admission NIHSS. Female sex contributes to poorer chronic functional outcomes after AIS.

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Section: Discussionsupporting

confidence: 92%

Emergency Department Arrival Times, Treatment, and Functional Recovery in Women with Acute Ischemic Stroke

Knauft

Chhabra

McCullough

2010

Journal of Women's Health

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“…18 -20 There has been only 1 previous prospective population-based study of behavior of patients immediately after TIA, but only 138 patients were assessed, delay was assessed categorically, minor strokes were excluded, and the characteristics of patients who had a TIA but only sought medical attention after an early recurrent stroke were not analyzed in detail. 21 A recent systematic review of delays to seeking medical attention after TIA 22 highlighted the lack of high-quality data and the need for more research. To determine the feasibility of targets requiring patients with TIA or minor stroke to be assessed within 24 hours of their event, [23][24][25][26][27][28] we studied the initial perceptions and actions of patients in a population-based cohort of incident and recurrent TIA and stroke.…”

mentioning

confidence: 99%

Population-Based Study of Behavior Immediately After Transient Ischemic Attack and Minor Stroke in 1000 Consecutive Patients

Chandratheva

Lasserson

Geraghty

et al. 2010

Stroke

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on behalf of the Oxford Vascular StudyBackground and Purpose-Most guidelines now recommend that patients with minor stroke or high-risk transient ischemic attack (TIA) are assessed within 24 hours of their event, but the feasibility of this depends on patients' behavior. We studied behavior immediately after TIA and minor stroke according to clinical characteristics, patients' perception of the nature of the event, and their predicted stroke risk. Methods-In a population-based study in Oxfordshire, UK, with face-to-face interview of 1000 consecutive patients with TIA and minor stroke (National Institutes of Health Stroke Scale Յ5) from 2002 to 2007 (Oxford Vascular Study), we studied delay in seeking medical attention and identified patients who did not seek attention after an initial event and only presented after a recurrent stroke. Results-Of 1000 patients (459 TIAs, 541 minor strokes), 300 (67%) with TIA and 400 (74%) with minor stroke sought medical attention within 24 hours and 208 (47%) and 234 (46%), respectively, sought attention within 3 hours. Most patients (77%) first sought attention through their primary care physician. In patients with TIA, incorrect recognition of symptoms, absence of motor or speech symptoms, shorter duration of event, lower ABCD 2 score, no history of stroke or atrial fibrillation, and weekend presentation were associated with significantly longer delays. However, age, sex, social class, and educational level were all unrelated to either correct recognition of symptoms or to delay in seeking attention. Of 129 patients with TIA or minor stroke who had a recurrent stroke within 90 days, 41 (31%) did not seek medical attention after their initial event. These patients were more likely to have had a TIA (Pϭ0.003), shorter duration of event (Pϭ0.02), and a history of TIA (Pϭ0.09) and less likely to have had motor (Pϭ0.004) or speech symptoms (Pϭ0.04) compared with those patients who sought medical attention for their initial event.Conclusion-Approximately 70% of patients do not correctly recognize their TIA or minor stroke, 30% delay seeking medical attention for Ͼ24 hours, regardless of age, sex, social class, or educational level, and approximately 30% of early recurrent strokes occur before seeking attention. Without more effective public education of all demographic groups, the full potential of acute prevention will not be realized. (Stroke. 2010;41:1108-1114.)

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“…As several studies suggest that the population awareness and response to transient symptoms are different 15 , transient ischemic attacks (TIAs) were excluded from this study. Patients or caregivers were contacted by a neurologist and questioned about their interpretation of their symptoms, and subsequent response, using a predesigned standardized questionnaire ( Figure 1).…”

Section: Methodsmentioning

confidence: 99%

Perception of stroke symptoms and utilization of emergency medical services

Hawkes

Farez

Calandri

et al. 2016

Arq. Neuro-Psiquiatr.

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Lack of stroke awareness and slow activation of emergency medical services (EMS) are frequently reported reasons for delayed arrival to the hospital. We evaluated these variables in our population. Methods Review of hospital records and structured telephone interviews of 100 consecutive stroke patients. Forward stepwise logistic regression was used for the statistical analysis. Results Seventy patients (75%) arrived at the hospital 4.5 hours after stroke symptoms onset. The use of EMS did not improve arrival times. Most patients who recognized their symptoms did not use EMS (p < 0.02). Nineteen patients (20%) were initially misdiagnosed. Eighteen of them were first assessed by non-neurologist physicians (p < 0.001). Conclusions Our population showed a low level of stroke awareness. The use of EMS did not improve arrival times at the hospital and the non-utilization of the EMS was associated with the recognition of stroke symptoms. There was a concerning rate of misdiagnosis, mostly by non-neurologist medical providers.

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A systematic review of delays in seeking medical attention after transient ischaemic attack

Abstract: systematic review of delays in seeking medical attention after transient ischaemic attack.

Cited by 49 publications

References 35 publications

Emergency Department Arrival Times, Treatment, and Functional Recovery in Women with Acute Ischemic Stroke

Emergency Department Arrival Times, Treatment, and Functional Recovery in Women with Acute Ischemic Stroke

Population-Based Study of Behavior Immediately After Transient Ischemic Attack and Minor Stroke in 1000 Consecutive Patients

Perception of stroke symptoms and utilization of emergency medical services

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