title: What is still missing in acute-phase treatment of stroke: a prospective observational study.
abstract: Early recognition of stroke symptoms and activation of emergency medical service (EMS) positively affects prognosis after a stroke. To assess stroke awareness among stroke patients and medical personnel in the catchment area of Verona Hospital and how it affects stroke care, we prospectively studied timing of acute stroke care in relation to patients' characteristics. Patients admitted to Medical Departments of Verona University Hospital between January 1st and December 31st 2009 with a diagnosis of TIA or stroke were enrolled. Outcome measures were: time between (i) symptoms onset and hospital arrival, (ii) hospital arrival and brain CT scan, blood examination, ECG and neurological evaluation. The following patient/event characteristics were also collected: means of hospital arrival, sex, age, degree of disability, type of event (first or recurrent) and acute-phase treatment. Of 578 patients providing complete information, 60 % arrived to the emergency department with the EMS (EMS+ group), while 40 % arrived on their own (EMS-). EMS+ group was older than EMS- (mean age 76.2, SD 13.2, vs. 72.3, SD 13, respectively), displayed more severe symptoms (mRS 4 vs. 2) and shorter time interval between symptoms onset and hospital arrival, hospital arrival and CT scan, ECG, laboratory tests and neurological evaluation (p < 0.0001); 22 % of the EMS+ patients were stroke recurrences versus 29 % of the EMS- (p = 0.058); 85 % of thrombolised patients were EMS+. We conclude that there is a lack of awareness of stroke symptoms and risks of recurrence even among patients who already had a stroke and among medical personnel.
authors.affiliation: Department of Neurological, Neuropsychological, Morphological and Motor Sciences, Section of Clinical Neurology, University of Verona, Policlinico GB Rossi, Piazzale LA Scuro, 10, 37134 Verona, Italy. sara.mazzucco@univr.it
authors.forename: Sara
authors.initials: S
authors.lastname: Mazzucco
authors.forename: Giulia
authors.initials: G
authors.lastname: Turri
authors.forename: Rina
authors.initials: R
authors.lastname: Mirandola
authors.forename: Paolo
authors.initials: P
authors.lastname: Bovi
authors.forename: Giulia
authors.initials: G
authors.lastname: Bisoffi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019370:Observation; D011446:Prospective Studies; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D020521:Stroke / Q000628:therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome