title: Delay in presentation and evaluation for acute stroke: Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.).
abstract: OBJECTIVE
  Early treatment is a critical determinant of successful intervention in acute stroke. The study was designed to find current patterns of stroke care by determining delays in time from onset of signs or symptoms to arrival at the emergency department and to initial evaluation by physicians and by identifying factors associated with these delays.
  
  
  METHODS
  Data were prospectively collected by nurses and physicians from patients, patients' family members, and medical records from 10 hospitals of the Robert Wood Johnson Health System in New Jersey.
  
  
  RESULTS
  A total of 553 patients who presented with signs or symptoms of acute stroke were studied. Thirty-two percent of patients arrived at the emergency department within 1.5 hours of stroke onset. Forty-six percent of patients arrived within 3 hours and 61% within 6 hours. Delays in arrival time were significantly associated with sex, race, transportation mode, and history of cardiovascular disease. Patients arriving by ambulance were more likely to present earlier (odds ratio [OR] 3.7 for arrival within 3 hours; OR 4.5 for arrival within 6 hours). Patients arriving by ambulance (OR 2.3 within 15 minutes; OR 1.7 within 30 minutes) and those requiring admission to intensive care units (OR 4.5 within 15 minutes and OR 5.2 within 30 minutes) were examined sooner by physicians.
  
  
  CONCLUSIONS
  Despite national efforts to promote prompt stroke evaluation and treatment, significant delays still exist. The lack of improvement throughout the past decade underscores the need for implementation of effective public health programs designed to minimize the time to evaluation and treatment of stroke.
authors.affiliation: Center for Disease Management and Clinical Outcomes, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ 08903-0019, USA. lacycr@umdnj.edu
authors.forename: C R
authors.initials: CR
authors.lastname: Lacy
authors.forename: D C
authors.initials: DC
authors.lastname: Suh
authors.forename: M
authors.initials: M
authors.lastname: Bueno
authors.forename: J B
authors.initials: JB
authors.lastname: Kostis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003710:Demography; D004494:Education Department, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009515:New Jersey / Q000453:epidemiology; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D044469:Racial Groups; D012042:Registries / Q000706:statistics & numerical data*; D017678:Sex Distribution; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology; D013997:Time Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data