title: Timing of arrival to a tertiary hospital after acute ischaemic stroke - A follow-up survey 5 years later.
abstract: BACKGROUND
  Intravenous tissue plasminogen activator (tPA) within 3 hours of stroke onset is a licensed proven therapy for ischaemic stroke, with recent trial data showing benefit up to 4.5 hours. We previously published in this journal data of a survey conducted in 2004 showing only 9% of ischaemic stroke patients presenting to the Singapore General Hospital (SGH) arrived within 2 hours of onset. We aimed to determine whether the problem of delayed hospital arrival persists in 2009 and to establish the impact of widening the time window for intravenous tPA to 4.5 hours.
  
  
  METHODS
  We prospectively surveyed consecutive ischaemic stroke patients admitted to the SGH from 9th March to 30th April 2009. Patients and/or relatives were interviewed with a standardised form similar to the 2004 survey.
  
  
  RESULTS
  Among the 146 ischaemic stroke patients surveyed (median age 67 years, 59% male, median NIHSS score 2), 6% presented to SGH within 2 hours and 15% within 3.5 hours of onset. Median time from stroke onset to hospital arrival was 1245 minutes (20.75 hours). Pre-hospital consultation was significantly associated with hospital arrival after 2 hours from onset. Main reasons cited for delay were not realising the gravity of symptoms (31%) and not recognising them as stroke (27%).
  
  
  CONCLUSIONS
  Delayed arrival to SGH following acute ischaemic stroke remains a problem in 2009. This confirms the lack of stroke awareness in Singapore and highlights the need for public stroke education. Furthermore, these data confirm that widening the time window for intravenous tPA treatment to 4.5 hours at SGH will increase its utilisation.
authors.affiliation: Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore. deidre.a.de.silva@sgh.com.sg
authors.forename: Deidre Anne
authors.initials: DA
authors.lastname: De Silva
authors.forename: Norazieda
authors.initials: N
authors.lastname: Yassin
authors.forename: April J P
authors.initials: AJ
authors.lastname: Toh
authors.forename: Dao Juan
authors.initials: DJ
authors.lastname: Lim
authors.forename: Wan Xin
authors.initials: WX
authors.lastname: Wong
authors.forename: Fung Peng
authors.initials: FP
authors.lastname: Woon
authors.forename: Hui Meng
authors.initials: HM
authors.lastname: Chang
mesh_terms: D000208:Acute Disease / Q000628:therapy; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D020521:Stroke / Q000628:therapy*; D013997:Time Factors