[Causes of a prolonged prehospital phase in patients admitted to a stroke unit. Can it be influenced by campaigns to educate the public?].
Since stroke has become a medical emergency because intravenous tissue plasminogen activator improves outcome after ischemic stroke within 3 h of symptom onset, the focus of acute stroke management lies on the prehospital phase. Having the worst median time of emergency department arrival after stroke onset according to nationwide statistics, we examined the factors influencing a late admission of 174 consecutive patients to our stroke unit and the effects of a public campaign over 5 months. The median time from symptom onset to arrival was 5.2 h; 36.4% of patients presented within 3 h at hospital. A high level of education, knowledge of the time window, direct contact with an emergency facility after stroke onset, high number of known symptoms, not living alone, and a stroke in the past were connected with an earlier presentation. The public campaign had a positive effect on median time of symptom onset to arrival from 12 h in July, 7.2 in August, 4.7 in October, 5.2 in November, and 3.2 in December 2002. This had a favorable effect on the number of thrombolysis.
Abteilung Neurologie der Dr.-Horst-Schmidt-Kliniken Wiesbaden, 65199 Wiesbaden. nikolaus.schmidt@hsk-wiesbaden.de
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Hüwel
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Weisner
D003422:Critical Care / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D006293:Health Promotion / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D020521:Stroke / Q000453:epidemiology* / Q000628:therapy*; D014850:Waiting Lists