title: Sources and reasons for delays in the care of acute stroke patients.
abstract: OBJECTIVE
  This study aimed to identify sources and reasons for delays in the care of our acute stroke patients.
  
  
  METHODS
  Data on time interval from symptom onset or awareness to initial presentation, to neurology assessment, to performance of cranial CT scan, and demographic and medical factors associated with delays among stroke patients admitted at St. Luke's Medical Center from May to October 2000 were obtained by interview and record review.
  
  
  RESULTS
  Of 259 patients (mean age 61.5+/-13.6 years, 43% females), 63% had infarction (INF), 32% intracerebral hemorrhage (ICH) and 5% subarachnoid hemorrhage (SAH). Fifty-nine percent presented within 3 h of symptom onset or awareness, 73% within 6 h (median=2 h). Patients with ICH presented earlier than those with infarction. Reasons for delayed consultation included failure to recognize symptoms as serious and stroke-related. A non-neurologist was initially consulted in 97% of cases. Median delay from presentation to neurology evaluation was 7.5 h. Median time from presentation to brain imaging was significantly shorter for patients brought to CT-equipped facilities (2 h) than for those needing transfer to other hospitals (11.5 h).
  
  
  CONCLUSIONS
  Patient delay in presentation is only one cause of delay in acute stroke care. Longer delays arise from healthcare-related factors such as delays in neurologist referral and neuroradiologic diagnosis. Professional and public education on the necessity of early neurologic evaluation and patient transport to CT-equipped "Stroke Centers" is recommended.
authors.affiliation: Institute for Neurosciences, St. Luke's Medical Center, 279 E. Rodriguez Sr. Blvd., 1102, Quezon City, Philippines. gigingyu@eudoramail.edu
authors.forename: Rosalind F
authors.initials: RF
authors.lastname: Yu
authors.forename: Maria Cristina Z
authors.initials: MC
authors.lastname: San Jose
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Manzanilla
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Oris
authors.forename: Robert
authors.initials: R
authors.lastname: Gan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking / Q000706:statistics & numerical data*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis; D002544:Cerebral Infarction / Q000150:complications / Q000175:diagnosis; D003710:Demography; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data; D010679:Philippines; D012017:Referral and Consultation / Q000706:statistics & numerical data; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis; D013996:Time and Motion Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data