title: Stroke symptoms and the decision to call for an ambulance.
abstract: OBJECTIVE
  Few acute stroke patients are treated with alteplase, partly because of significant prehospital delays after symptom onset. The aim of this study was to determine among ambulance-transported stroke patients factors associated with stroke recognition and factors associated with a call for ambulance assistance within 1 hour from symptom onset.
  
  
  METHODS
  For 6 months in 2004, all ambulance-transported stroke or transient ischemic attack patients arriving from a geographically defined region in Melbourne (Australia) to 1 of 3 hospital emergency departments were assessed. Tapes of the call for ambulance assistance were analyzed and the patient and the caller were interviewed.
  
  
  RESULTS
  One hundred ninety-eight patients were included in the study. Stroke was reported as the problem in 44% of ambulance calls. Unprompted stroke recognition was independently associated with facial droop (P=0.015) and a history of stroke or transient ischemic attack (P<0.001). More than half of the calls for ambulance assistance were made within 1 hour from symptom onset and only 43% of these callers spontaneously identified the problem as "stroke." Factors independently associated with a call within 1 hour were: speech problems (P=0.009), caller family history of stroke (P=0.017), and the patient was not alone at symptom onset (P=0.018).
  
  
  CONCLUSIONS
  Stroke was reported as the problem (unprompted) by <50% of callers. Fewer than half the calls were made within 1 hour from symptom onset. Interventions are needed to more strongly link stroke recognition to immediate action and increase the number of stroke patients eligible for acute treatment.
authors.affiliation: National Stroke Research Institute Level 1 Neurosciences Building, Austin Health, 300 Waterdale Road, Heidelberg Heights Victoria 3181, Australia. imosley@nsri.org.au
authors.forename: Ian
authors.initials: I
authors.lastname: Mosley
authors.forename: Marcus
authors.initials: M
authors.lastname: Nicol
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Donnan
authors.forename: Ian
authors.initials: I
authors.lastname: Patrick
authors.forename: Helen
authors.initials: H
authors.lastname: Dewey
mesh_terms: D000368:Aged; D000552:Ambulances; D003657:Decision Making; D004631:Emergency Medical Service Communication Systems; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D013689:Telephone; D013997:Time Factors; D014187:Transportation of Patients