title: A multicentre observational study of presentation and early assessment of acute stroke.
abstract: OBJECTIVE
  To investigate delays in the presentation to hospital and evaluation of patients with suspected stroke.
  
  
  METHODS
  Multicentre prospective observational study.
  
  
  METHODS
  22 hospitals in the United Kingdom and Dublin.
  
  
  METHODS
  739 patients with suspected stroke presenting to hospital.
  
  
  METHODS
  Time from onset of stroke symptoms to arrival at hospital, and time from arrival to evaluation by a senior doctor.
  
  
  RESULTS
  The median age of patients was 75 years, and 400 were women. The median delay between onset of symptoms and arrival at hospital was 6 hours (interquartile range 1 hour 48 minutes to 19 hours 12 minutes). 37% of patients arrived within 3 hours, 50% within 6 hours. The median delay for patients using the emergency service was 2 hours 3 minutes (47 minutes to 7 hours 12 minutes) compared with 7 hours 12 minutes (2 hours 5 minutes to 20 hours 37 minutes) for referrals from general practitioners (P<0.0001). Use of emergency services reduced delays to hospital (odds ratio 0.45, 95% confidence interval 0.23 to 0.61). The median time to evaluation by a senior doctor was 1 hour 9 minutes (interquartile range 33 minutes to 1 hour 50 minutes) but was undertaken in only 477 (65%) patients within 3 hours of arrival. This was not influenced by age, sex, time of presentation, mode of referral, hospital type, or the presence of a stroke unit. Computed tomography was requested within 3 hours of arrival in 166 (22%) patients but undertaken in only 60 (8%).
  
  
  CONCLUSIONS
  Delays in patients arriving at hospital with suspected stroke can be reduced by the increased use of emergency services. Over a third of patients arrive at hospital within three hours of stroke; their management can be improved by expediting medical evaluation and performing computed tomography early.
authors.affiliation: Department of Medicine, Guy's King's, and St Thomas's Medical School, London SE5 9PJ.
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Harraf
authors.forename: Anil K
authors.initials: AK
authors.lastname: Sharma
authors.forename: Martin M
authors.initials: MM
authors.lastname: Brown
authors.forename: Kennedy R
authors.initials: KR
authors.lastname: Lees
authors.forename: Richard I
authors.initials: RI
authors.lastname: Vass
authors.forename: Lalit
authors.initials: L
authors.lastname: Kalra
mesh_terms: D000208:Acute Disease; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis*; D013996:Time and Motion Studies; D006113:United Kingdom