Influence of Stroke Knowledge on Pre-hospital Delay of Acute Ischemic Stroke Patients

Lee, Jae Jin; Choo, In Sung; Kim, Hoo Won; Kim, Jin Ho; Ahn, Seong Hwan

Abstract

BACKGROUND: Most stroke patients are unable to receive thrombolytic therapy because they do not reach a hospital within 3 hours from symptom onset. The aim of this study was to determine the factors (including knowledge of stroke) that affect the admission delay.
METHODS
From May 2007 to December 2007, consecutive ischemic stroke patients presenting within 3 days from symptom onset and their relatives were interviewed about their knowledge of the following aspects of stroke: stroke warning signs, thrombolytic therapy, the 3-hour time limit for admission delay, and use of emergency medical services. Clinical data of patients were collected from medical records.
RESULTS
One hundred and fifty-three patients were finally included, 37 of which (24.2%) reached our hospital within 3 hours from symptom onset. In univariate and multivariate analyses, factors independently associated with an admission delay of less than 3 hours were age (odds ratio [OR]=0.95, 95% confidence interval [CI]=0.91.0.99; p=0.008), atrial fibrillation (OR=5.02, CI=1.35.18.70; p=0.016), NIHSS score at admission (OR=1.09, CI=1.01.1.18; p=0.028), and knowledge of the 3-hour time limit (OR=3.55, CI=1.45.8.72; p=0.006). In the patients with an NIHSS score of >4 points, knowledge of the 3-hour time limit was the only independent factor associated with an admission delay of less than 3 hours. This knowledge was significantly associated with graduation from high school (p=0.038).
CONCLUSIONS
Knowledge of the 3-hour time limit was the only modifiable factor that influenced an admission delay of less than 3 hours. Therefore, educating the public about stroke, including about the 3-hour time limit, could increase the ability to apply thrombolysis to acute stroke patients.