Abstract 57: Seeking Support For Symptoms Of Stroke Delays Emergency Medical Service Activation For Thai Women And Men

Abstract

Background: National stroke campaigns have been implemented to improve stroke knowledge and awareness for the Thai public. Despite these efforts, only a minority of people recognize stroke symptoms and seek treatments within 4.5 hours after symptom onset. Studies reveal sex differences in stroke knowledge, which contributes to delayed treatment-seeking actions. Purpose: This study aimed to examine sex differences in stroke knowledge, symptoms, stroke recognition, and initial action between men and women after experiencing acute strokes. Methods: A cross-sectional study was conducted at three hospitals in Thailand between September and November 2020. Medical record reviews and patient interviews were completed within seven days of admission. Standardized questionnaires for prior stroke knowledge (stroke warning signs & proper actions), clinical manifestation, stroke recognition, first action, and the activation of the emergency medical service (EMS) were used. Results: A total of 170 patients (54% men) with a median age of 63 years were included. Mean scores for prior stroke knowledge were higher in men compared to women (2.97 vs. 2.23, p = .02). Men were more likely than women to identify sudden numbness or weakness and sudden trouble walking or dizziness as stroke warning signs (62% vs. 42%, p = .01; 57% vs. 40%, p = .03, respectively). Women more frequently experienced severe headache (37% vs. 18%, p < .01). No significant differences between men and women were found in stroke recognition (20% vs. 26%) and activation of the EMS system (22% vs. 19%). Seeking support from someone nearby or on the phone was the most frequent first action in men (47%) and women (55%), which often delayed EMS activation. Conclusion: Even though men scored higher in stroke knowledge than women, challenges to activating the EMS were found in both sexes, highlighting the need to explore targeted educational material and knowledge translation among high-risk stroke patients and their relatives, regardless of sex.

Decision Delay Is a Significant Contributor to Prehospital Delay for Stroke Symptoms

“…Based on the prehospital delay phases identified in the literature and findings from the pilot study (Potisopha et al, 2020), the total prehospital delay was divided into the following five phases: (a) Pre-recognition: the last known normal time to the time that the patient/bystander recognized the symptoms; (b) Decision delay: the time of symptom onset or symptom recognition/discovery to the time a decision or judgment was reached or made to seek treatment or call EMS; (c) Waiting delay: the time of post-decision to seek treatment to the departure time from the scene; (d) Transportation delay: the departure time to the time of arrival at the first hospital; and (e) Referral delay: the time the patients arrived at the initial/first hospital to the time the patient reached the ED of a stroke center facility. The delay times for each phase, including pre-recognition, decision, waiting, and transportation, were obtained from the patient interviews and medical records.…”

“…Prior to implementing the study, we conducted a pilot to test the feasibility of accessing research participants and the acceptability of the research instruments. Ten acute stroke patients were interviewed in a face-to-face approach (Potisopha et al, 2020). They were recruited within 3–49 hours after ED admission and were able to complete all five questionnaires in a face-to-face interview.…”