Temporal trends in public awareness of stroke: warning signs, risk factors, and treatment.
OBJECTIVE
Delay in seeking medical attention after stroke symptom onset is the most important reason for low rates of thrombolytic use for ischemic stroke (IS) in the United States. This may be related to poor recognition of stroke symptoms, or to lack of awareness of time-sensitive stroke treatments. We describe public knowledge of t-PA as a treatment for IS, as well as changes over time in knowledge of stroke warning signs (WS) and risk factors (RF).


METHODS
Survey respondents were drawn from our biracial population of 1.3 million using random-digit dialing in 1995, 2000, and 2005 to reflect the age, race, and gender distribution of stroke patients, based on an ongoing stroke incidence study in the same region. They were asked open-ended questions regarding stroke WS, RF, and, in 2005, specific questions regarding t-PA. Comparisons over time were made using chi(2) analysis, and were corrected for multiple comparisons.


RESULTS
Over the 10-year study period, 6209 surveys were completed. Knowledge of WS and RF improved between 1995 and 2000. Between 2000 and 2005, knowledge did not improve significantly; however, there was a significant improvement in knowledge of 3 warning signs (12% in 1995 vs 16% in 2005, P=0.0004). In 2005, only 3.6% of those surveyed were able to independently name t-PA or "clot buster" when asked: "Suppose you were having a stroke. Do you know of any medication your doctor could give you into the vein to increase your chance of recovering from a stroke?"-although 19% claimed to have heard of t-PA once it was mentioned to them.


CONCLUSIONS
Despite numerous national stroke public awareness campaigns, public knowledge of stroke WS and RF has not improved over the last 5 years. In addition, knowledge of t-PA as a treatment for IS is extremely poor. Public awareness messages in the future should focus on the possibility of urgent treatments, in addition to stroke WS and RF, so the public can translate their knowledge into action and present to medical attention more quickly. This may be the highest yield approach to increasing rates of treatment of IS with t-PA.
Kleindorfer
Dawn
D
Department of Neurology, University of Cincinnati, Cincinnati, OH 45267, USA. dawn.kleindorfer@uc.edu
Khoury
Jane
J
Broderick
Joseph P
JP
Rademacher
Eric
E
Woo
Daniel
D
Flaherty
Matthew L
ML
Alwell
Kathleen
K
Moomaw
Charles J
CJ
Schneider
Alex
A
Pancioli
Arthur
A
Miller
Rosie
R
Kissela
Brett M
BM
D000328:Adult; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006266:Health Education / Q000639:trends*; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator