Rapid response to stroke symptoms: the Delay in Accessing Stroke Healthcare (DASH) study.
OBJECTIVE
To assess the determinants of prehospital delay for patients with presumed acute cerebral ischemia (ACI) in order to provide the background necessary to develop interventions to shorten such delays.


METHODS
A prospective registry of patients presenting to the ED with signs and symptoms of stroke was established at a university hospital from July 1995 to March 1996. Trained nurses performed a structured ED interview, which assessed prehospital delay and potential confounders.


RESULTS
The median delay (interquartile range) from symptom onset to ED arrival for all patients seeking care for stroke-like symptoms (n = 152) was 3.0 hours (1.5-7.8 hr). The median delay from symptom onset to ED arrival was less in cases where a witness first recognized that there was a serious problem than it was when the patient first identified the problem. A heightened sense of urgency by the patient about his or her symptoms, and use of 911/emergency medical services (EMS) transport were also associated with rapid arrival in the ED within 3 hours of symptom onset. After adjusting for all predictor variables in a multivariable logistic regression model, only recognition of symptoms by a witness and calling 911/EMS transport remained statistically significant.


CONCLUSIONS
These data suggest that future efforts to intervene on prolonged prehospital delay for patients with ACI should include strategies for the community as a whole as well as persons at risk for stroke and should reinforce the use of 911 and EMS transport.
Rosamond
W D
WD
Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC. wayne_rosamond@unc.edu
Gorton
R A
RA
Hinn
A R
AR
Hohenhaus
S M
SM
Morris
D L
DL
D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009730:Nursing Assessment; D010342:Patient Acceptance of Health Care; D010343:Patient Admission; D011446:Prospective Studies; D012042:Registries; D011795:Surveys and Questionnaires; D013997:Time Factors