title: Effects of public and professional education on reducing the delay in presentation and referral of stroke patients.
abstract: OBJECTIVE
  Several emerging stroke therapies require patients to be treated within several hours of symptom onset. Past studies have documented a significant delay between symptom onset and hospital presentation. As part of an experimental treatment study using tissue-type plasminogen activator, we began a multifaceted program of public and professional education to reduce the delay in presentation and referral of acute stroke patients.
  
  
  METHODS
  The educational efforts focused on improving the recognition of stroke symptoms, the study enrollment criteria, and the need for rapid treatment of stroke patients. This program included 1) interviews on television and radio, 2) newspaper articles, 3) lectures to local and regional primary care and emergency department physicians, 4) mailings to several thousand local physicians, 5) having neurologists on-call for referrals 24 hrs/day, and 6) use of the Duke Life-Flight helicopter.
  
  
  RESULTS
  Since starting our program, 139 of 159 (86%) patients with cerebral infarction presented primarily to our were referred to our facility within 24 hours of symptom onset, compared with 70 of 187 (37%) before our educational efforts (p less than 0.00001). No significant change was seen in patients with intracerebral hemorrhage (23 of 30 +AD77%+BD within 24 hours after program, compared with 25 of 40 +AD63%+BD before educational efforts; p = 0.30).
  
  
  CONCLUSIONS
  These findings suggest that educational efforts aimed at the public and health professionals may increase recognition of stroke symptoms and reduce the delay in presentation and referral of stroke patients.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC 27710.
authors.forename: M J
authors.initials: MJ
authors.lastname: Alberts
authors.forename: A
authors.initials: A
authors.lastname: Perry
authors.forename: D V
authors.initials: DV
authors.lastname: Dawson
authors.forename: C
authors.initials: C
authors.lastname: Bertels
mesh_terms: D002543:Cerebral Hemorrhage; D002544:Cerebral Infarction; D002561:Cerebrovascular Disorders / Q000628:therapy; D004502:Education, Medical, Continuing; D005500:Follow-Up Studies; D006801:Humans; D011641:Public Relations; D012017:Referral and Consultation; D013997:Time Factors