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

Abstract

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.)

Factors Associated With Onset-to-Door Time in Patients With Transient Ischemic Attack Admitted to Stroke Centers

“…The results of our study are consistent with those of previous studies. 3,5,8 Two reports using data from the Oxford Vascular Study 3,5 demonstrated that patients with motor weakness, speech disturbance, and symptom duration >60 minutes were less likely than other patients to delay in seeking medical attention. Patients with a higher predicted stroke risk were more likely to act quickly due apparently to the influence of weakness and prolonged symptom duration on behavior, although there was no association between the recognition of symptoms and the urgency of action.…”

“…Although the behavior of patients after stroke has been studied extensively since the advent of thrombolysis and other potential treatments, little information is available on the behavior of patients after TIA, except for the Oxford Vascular Study. [3][4][5] We investigated the factors associated with the time from symptom onset to arrival at a stroke center (onset-to-door time [ODT]) in patients with TIA admitted to stroke centers using data from a multicenter, retrospective study.…”

Clinical Types and Outcome of Minor Ischemic Stroke in Northern China: A Retrospective Cohort Study

“…All patients were reassessed during the 6 months follow-up, and were classified as "no symptoms or minor symptoms" (score 0 or 1), "lifestyle restriction" [2] [3], "dependent" [4] [5] according to the stroke-related handicap scale [11], and "death" [6] in our study. The follow-up information was gathered by the same neurology specialist, who conducted inquiries by phone.…”

“…With magnetic resonance imaging (MRI) advances, several epidemiological studies have reported that the incidence of minor ischemic stroke (MIS) is up to 55% -74% in metropolitan regions [1] [2], showing MIS is a common ischemic stroke appearing in world regions. In such studies, small stroke or lacunar stroke was usually considered favorable short-term outcome and having had a very low NIHSS score, so this is why it is considered a MIS [3] [4].…”

Improving Recognition and Response to the Onset of Stroke

“…29 As their neighbors across the pond have experienced, one of the primary reasons for this low rate of thrombolytic therapy is the lack of an urgent response when stroke symptoms are noted by patients or witnesses. [30][31][32][33] Some of the factors that contribute to this delay include the following:…”