title: Factors related to decision delay in acute stroke.
abstract: BACKGROUND
  The time from symptom onset to seeking medical assistance (decision delay) accounts for a proportion of prehospital delay in acute stroke. The aims of this study were to identify factors related to decision delay and calling the emergency medical services (EMS) as the first medical contact.
  
  
  METHODS
  Data were prospectively collected from 350 patients with acute stroke or transient ischemic attack. Data on decision delay, prehospital delay, types of first medical contact, and previous stroke knowledge were recorded. Multivariable logistic regression analyses were conducted to identify factors related to decision delay of 1 hour or less and calling the EMS as the first medical contact.
  
  
  RESULTS
  The median decision delay was 2.0 hours. Decision delay accounted for 62.3% of prehospital delay (median value). Moderate (National Institutes of Health Stroke Scale [NIHSS] score 8-16; odds ratio [OR] 4.16 [95% confidence interval 1.86-9.30]) or severe symptoms (NIHSS score ≥ 17; OR 10.38 [2.70-39.90]) and living together (OR 1.84 [1.02-3.43]) were associated with decision delay of 1 hour or less. Moderate (OR 6.31 [2.79-14.29]) or severe symptoms (OR 8.44 [2.64-26.98]) were associated with calling the EMS as the first medical contact. Previous stroke knowledge did not affect an early decision or EMS use.
  
  
  CONCLUSIONS
  The decision to seek medical assistance in acute stroke accounts for more than half of the prehospital delay. Severity of symptoms and living together are related to an early decision (≤1 hour). Previous stroke knowledge does not affect decision delay or EMS use.
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway; Department of Neurology, Akershus University Hospital, Lørenskog, Norway. Electronic address: kashiffaiz@gmail.com.
authors.forename: Kashif Waqar
authors.initials: KW
authors.lastname: Faiz
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway; Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Antje
authors.initials: A
authors.lastname: Sundseth
authors.affiliation: Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Bente
authors.initials: B
authors.lastname: Thommessen
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway; Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Ole Morten
authors.initials: OM
authors.lastname: Rønning
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001364:Awareness; D016009:Chi-Square Distribution; D002755:Choice Behavior; D057210:Delayed Diagnosis; D004632:Emergency Medical Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D010361:Patients / Q000523:psychology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D013997:Time Factors; D061665:Time-to-Treatment
keywords: Prehospital delay; behavior; decision; stroke; stroke knowledge; thrombolysis