title: Population-based intervention to reduce prehospital delays in patients with cerebrovascular events.
abstract: BACKGROUND
  In patients with acute stroke, systemic thrombolysis needs to be administered within 3 hours of symptom onset. The aim of the present study was to reduce prehospital delays in a population-based intervention.
  
  
  METHODS
  We performed a cluster-randomized trial with 48 zip code areas as cluster units in the catchment area of 3 inner-city hospitals in Berlin, Germany. The primary end point was time between symptom onset and hospital admission. The intervention consisted of an educational letter indicating stroke symptoms and emphasizing the importance of calling the emergency medical services. We additionally included a bookmark and sticker with the emergency medical services' telephone number. We fitted a series of log-normal survival regression models (time to admission) with frailty terms shared by inhabitants of the same zip code area.
  
  
  RESULTS
  A total of 75 720 inhabitants received the intervention. Between 2004 and 2005, 741 patients with cerebrovascular events were admitted from the control areas (n = 24) and 647 from the intervention areas (n = 24). A prehospital time of 2 hours or less and 3 hours or less was achieved by 22% and 28% of patients, respectively, in the control group compared with 26% and 34%, respectively, in the intervention group. In the log-normal model, time to hospital was reduced by 27% in the intervention group in women (acceleration factor, 0.73; 95% confidence interval, 0.58-0.94), while no significant effect was found in men.
  
  
  CONCLUSIONS
  The population-based intervention was effective in reducing prehospital delays in women but not in men. Future research should focus on the potential transferability of the intervention, its sustainability, and sex-specific impact.
authors.affiliation: Berlin School of Public Health, Charité University Medical Center, Oudenarder Str 16, Berlin D-13347, Germany. jacqueline.mueller-nordhorn@charite.de
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Müller-Nordhorn
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Christian H
authors.initials: CH
authors.lastname: Nolte
authors.forename: Gerhard J
authors.initials: GJ
authors.lastname: Jungehülsing
authors.forename: Karin
authors.initials: K
authors.lastname: Rossnagel
authors.forename: Andreas
authors.initials: A
authors.lastname: Reich
authors.forename: Stephanie
authors.initials: S
authors.lastname: Roll
authors.forename: Arno
authors.initials: A
authors.lastname: Villringer
authors.forename: Stefan N
authors.initials: SN
authors.lastname: Willich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors