title: Delay between symptom onset and clinic attendance following TIA and minor stroke: the BEATS study.
abstract: BACKGROUND
  rapid specialist assessment of patients with transient ischaemic attack (TIA) reduces the risk of recurrent stroke. National guidelines advise that high-risk patients are assessed within 24 h and low-risk patients within 7 days.
  
  
  OBJECTIVE
  to quantify delay and map pathways taken by patients from symptom onset to specialist assessment.
  
  
  METHODS
  retrospective cohort study.
  
  
  METHODS
  rapid access TIA clinic.
  
  
  METHODS
  structured interviews with 278 patients newly diagnosed with TIA (222) or minor stroke (56), and examination of medical records.
  
  
  RESULTS
  of the 133 high-risk TIA patients, 11 (8%) attended the clinic within 24 h of symptom onset; of the 89 low-risk TIA patients, 47 (53%) attended within 7 days. Median delay between symptom onset and seeking help from a healthcare professional (HCP) was 4.0 h (IQR 0.5, 41.3). Delay was less if symptoms were correctly interpreted but not reduced by a publicity campaign (FAST) to encourage an urgent response. Most patients (156, 56%) first contacted a general practitioner (GP) and 46 (17%) called an ambulance or attended the emergency department. Over a third (36%) had a second consultation with an HCP before attending the clinic, and this was more likely in those presenting to paramedics, out of hours GP services or optometry. Time to clinic attendance was less if an emergency pathway was used and greater if patients were seen by a second HCP.
  
  
  CONCLUSIONS
  factors contributing to delay include incorrect interpretation of symptoms and failure to invoke emergency services. Delays after presentation could be addressed by direct referral by out of hours services, paramedics and optometrists.
authors.affiliation: Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, UK.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Wilson
authors.forename: Dawn
authors.initials: D
authors.lastname: Coleby
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Taub
authors.forename: Claire
authors.initials: C
authors.lastname: Weston
authors.forename: Thompson G
authors.initials: TG
authors.lastname: Robinson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D002983:Clinical Competence; D019091:Critical Pathways; D004636:Emergency Service, Hospital; D005260:Female; D058006:General Practice; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D012017:Referral and Consultation; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology; D013997:Time Factors
keywords: acute care; emergency medical services; general practice; older people; stroke; transient ischaemic attack