Concordance of stroke symptom onset time. The Second Delay in Accessing Stroke Healthcare (DASH II) Study.
OBJECTIVE
This study examines the concordance between symptom onset obtained during an interview in the emergency department (ED) compared to that recorded in the medical record among patients with stroke-like symptoms and characterizes the frequency of missing symptom onset information in the medical record.


METHODS
Interviews with patients presenting with signs and symptoms of acute stroke were completed in the ED of seven hospitals to determine symptom onset time. Symptom onset recorded in the medical record was abstracted after the patient was discharged.


RESULTS
Among the patients who presented to the ED with stroke-like symptoms, 60.2% overall and 61.9% among stroke patients had a symptom onset date and time recorded in the medical record. The Pearson correlation of prehospital delay time, comparing symptom onset obtained by interview to that obtained by the medical record was 0.80 and among stroke patients was 0.91. Concordance of prehospital delay time for stroke within +/- 1 h between the interview and the medical record was 60.1%. For stroke patients, concordance was more likely for those who had higher functional status prior to the acute episode.


CONCLUSIONS
Symptom onset time was often missing from the medical record. Standardized and systematic recording of delay time in the medical record could increase its utility as a clinical measure and as a research tool for acute stroke.
Wake Forest University School of Medicine, Winston-Salem, NC, USA. kelly_evenson@unc.edu
K R
KR
Evenson
W D
WD
Rosamond
J A
JA
Vallee
D L
DL
Morris
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003120:Colorado / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic / Q000592:standards; D008487:Medical History Taking / Q000592:standards*; D008499:Medical Records / Q000592:standards*; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009657:North Carolina / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D015203:Reproducibility of Results; D013022:South Carolina; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D013997:Time Factors