title: Presenting symptoms and onset-to-arrival time in patients with acute stroke and transient ischemic attack.
abstract: Delayed arrival to the emergency department (ED) precludes most stroke patients from receiving thrombolytic treatment. Our objective in this study was to examine the association between presenting symptoms and onset-to-arrival time (ie, time between onset of symptoms to arrival at the ED) in a statewide stroke registry. Demographics, clinical data, and presenting symptoms were collected for patients with acute stroke or symptomatic transient ischemic attack (TIA) admitted to 15 Michigan hospitals (n = 1922). Polytomous logistic regression models were developed to test the association between presenting symptoms and onset-to-arrival time (classified as <2 hours, 2-6 hours, or >6 hours/unknown). Onset-to-arrival time was <2 hours in 19% of the patients, 2-6 hours in 22%, and >6 hours/unknown in 59%. Unilateral symptoms (reported by 40%) and speech difficulties (reported by 22%) were associated with increased likelihood of arriving within 2 hours (unilateral: adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.1-1.9; speech: aOR, 1.6; 95% CI, 1.2-2.2). Difficulty with walking, balance, or dizziness (12%), confusion (9%), loss of consciousness (6.7%) and falls (3.4%) were associated with lower likelihood of arriving within 2 hours (walking: aOR, 0.7; 95% CI, 0.4-1.0; confusion: aOR, 0.5; 95% CI, 0.3-0.8; consciousness: aOR, 0.5; 95% CI, 0.1-0.9; falls: aOR, 0.4; 95% CI, 0.3-0.9). Presenting symptoms were strongly associated with time of arrival; patients with unilateral symptoms and speech difficulties were more likely to seek care early. Future studies should consider including more specific patient-level data to identify psychosocial and behavioral aspects of recognition and action to stroke symptoms.
authors: Department of Epidemiology, Michigan State University, East Lansing, MI 48824, USA.
authors: Julia Warner
authors: JW
authors: Gargano
authors: Susan
authors: S
authors: Wehner
authors: Mathew J
authors: MJ
authors: Reeves
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003221:Confusion / Q000209:etiology; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D016015:Logistic Models; D008297:Male; D008824:Michigan; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D004856:Postural Balance; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012678:Sensation Disorders / Q000209:etiology / Q000503:physiopathology; D013064:Speech Disorders / Q000209:etiology; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D013997:Time Factors; D014786:Vision Disorders / Q000209:etiology