Abstract WP251: Symptoms And Delay Of Hospital Visit In Stroke Patients

Abstract

Objective: Time is an important factor in treating stroke patients. Symptoms which are recognized by patients and/or bystander seem to influence how soon they visit the hospital. Here we examined this issue. Materials and Methods: A consecutive series of 469 patients was collected prospectively between May 2007 and March 2009. All patients were admitted within 2 weeks after the onset. Median age of patients was 75 years old. Results: The median time interval between recognition of symptoms and hospital visit (“delay”) was 6.6 hours. Interview from patients and/or bystander revealed that they recognized disturbance of consciousness (“Cons”) in 83, dysarthria in 148, aphasia in 23, facial weakness (“Facial”) in 25, weakness of upper limb (“U/E”) in 174, weakness of lower limb (“L/E”) in 204, sensory disturbance (“Sensory”) in 63, visual problem (“Visual”) in 11, headache in 53, nausea and/or vomiting (“N/V”) in 57, and lightheadedness in 57, respectively. The median “delay” with each symptom was 1.0h with “Cons”, 1.1h with aphasia, 2.4h with headache, 2.4h with “N/V”, 3.6h with “Facial”, 5.1h with “U/E”, 5.9h with dysarthria, 8.3h with “Visual”, 10.2h with “L/E”, 16.6h with lightheadedness, and 24.7h with “Sensory”, respectively. Median NIHSS score at the initial examination (iNIHSS) was 4.0. There was a significant negative correlation between “delay” and iNIHSS in overall, “Cons”, dysarthria, “U/E”, “L/E” and “Sensory”, but not in aphasia, “Facial”, “Visual”, headache, “N/V”, and lightheadedness. Neurological examination by board-certified strokologists revealed “Cons” in 110, dysarthria in 250, aphasia in 72, “Facial” in 167, “U/E” in 254, “L/E” in 249, “Sensory” in 183, and “Visual” in 33, respectively. This means that only 15% of “Facial”, 32% of aphasia, 33% of “Visual”, and 34% of “Sensory” was recognized by patients and/or bystander, respectively. Conclusions: There was a significant negative correlation between “delay” and iNIHSS; however, there were several symptoms which caused early hospital visit regardless of severity of iNIHSS. Aphasia and “Facial” caused early hospital visit, however, only 15% and 32% of patients and/or bystander recognized these symptoms, respectively. The enlightenment to the general public is required.