title: Timing of hospital presentation after acute cerebral infarction and patients' acceptance of intravenous thrombolysis.
abstract: BACKGROUND
  Intravenous thrombolysis has been shown to improve outcome after acute cerebral infarction if given within 3 hours of symptom onset. There are no data in Singapore on the timing of hospital presentation after acute cerebral infarction as well as factors and reasons for delayed presentation.
  
  
  METHODS
  As intravenous thrombolysis has recently been licensed for use in acute cerebral infarction in Singapore, we studied 100 consecutive acute cerebral infarction admitted to the Singapore General Hospital for timing of hospital presentation, reasons associated with delay in presentation and hypothetical acceptance of intravenous thrombolysis.
  
  
  RESULTS
  Only 9% of patients presented to hospital within 2 hours of symptom onset. Factors associated with hospital presentation within 2 hours were a large stroke and lack of pre-hospital consultation. Failure to recognise the severity of symptoms and inability to seek medical attention unaided were the 2 most common reasons for delayed presentation. One-third of patients or their relatives hypothetically would accept intravenous thrombolysis, suggesting that a thrombolysis service is feasible at the Singapore General Hospital. However, it would be hindered by the low proportion of patients who present early to hospital after symptom onset.
  
  
  CONCLUSIONS
  Our results support the need for a public education programme to highlight the identification of stroke symptoms and the need to present to hospital as soon as possible after the onset of stroke symptoms.
authors.affiliation: National Neuroscience Institute, Singapore General Hospital campus, Singapore.
authors.forename: Deidre Anne
authors.initials: DA
authors.lastname: De Silva
authors.forename: Sea-Hing
authors.initials: SH
authors.lastname: Ong
authors.forename: Danny
authors.initials: D
authors.lastname: Elumbra
authors.forename: Meng-Cheong
authors.initials: MC
authors.lastname: Wong
authors.forename: Christopher L H
authors.initials: CL
authors.lastname: Chen
authors.forename: Hui-Meng
authors.initials: HM
authors.lastname: Chang
mesh_terms: D000208:Acute Disease; D000368:Aged; D002544:Cerebral Infarction / Q000188:drug therapy* / Q000503:physiopathology; D004636:Emergency Service, Hospital; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006769:Hospitals, General; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012846:Singapore; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents