title: First impression at stroke onset plays an important role in early hospital arrival.
abstract: BACKGROUND
  Treatment for acute ischemic stroke should be administered as soon as possible after symptom onset. The aim of this study was to investigate whether or not the patient's and bystander's first impression at stroke onset was associated with hospital arrival time.
  
  
  METHODS
  To investigate the factors influencing the prehospital delay, we prospectively interviewed consecutive stroke patients and bystanders about their first impression at the stroke onset and assessed the methods of transportation, and clinical characteristics. Early arrival was defined as a hospital arrival of within 2 h from stroke onset.
  
  
  RESULTS
  One hundred thirty patients were enrolled: 82% were ischemic stroke and 18% were cerebral hemorrhage. The median interval between symptom onset and the hospital arrival was 7.5 h and 30% of patients presented within 2 h of stroke onset. First impression of stroke (odds ratios [OR] 4.56, 95% confidence interval [CI] 1.54-13.5, p=0.006), presence of consciousness disturbance (OR 4.29, CI 1.39-13.3, p=0.011), arrival through other facilities (OR 0.25, CI 0.08-0.76, p=0.015), a history of diabetes (OR 0.23, CI 0.06-0.80, p=0.028) and nocturnal onset (OR 0.19, CI 0.04-0.88, p=0.042) independently contributed to the early arrival.
  
  
  CONCLUSIONS
  The first impression of patients and bystanders at stroke onset is important in order to reach hospital earlier in Japan. Public educational systems such as those, which advertise stroke warning signs, are necessary.
authors: Stroke Center, Department of Stroke Medicine, Kawasaki Medical School, Kurashiki.
authors: Yasuyuki
authors: Y
authors: Iguchi
authors: Kuniyasu
authors: K
authors: Wada
authors: Kensaku
authors: K
authors: Shibazaki
authors: Takeshi
authors: T
authors: Inoue
authors: Yuji
authors: Y
authors: Ueno
authors: Shinji
authors: S
authors: Yamashita
authors: Kazumi
authors: K
authors: Kimura