title: Patient awareness and perception of stroke symptoms and the use of 911.
abstract: BACKGROUND
  Response to stroke symptoms and the use of 911 can vary by race/ethnicity. The quickness with which a patient responds to such symptoms has implications for the outcome and treatment. We sought to examine a sample of patients receiving a Remote Evaluation of Acute isCHemic stroke (REACH) telestroke consult in South Carolina regarding their awareness and perception of stroke symptoms related to the use of 911 and to assess possible racial/ethnic disparities.
  
  
  METHODS
  As of September 2013, 2325 REACH telestroke consults were conducted in 13 centers throughout South Carolina. Telephone surveys assessing use of 911 were administered from March 2012-January 2013 among 197 patients receiving REACH consults. Univariate and multivariate logistic regression was performed to assess factors associated with use of 911.
  
  
  RESULTS
  Most participants (73%) were Caucasian (27% were African-American) and male (54%). The mean age was 66 ± 14.3 years. Factors associated with use of 911 included National Institutes of Health Stroke Scale scores >4 (odds ratio [OR], 5.4; 95% confidence interval [CI], 2.63-11.25), unknown insurance which includes self-pay or not charged (OR, 2.90; 95% CI, 1.15-7.28), and perception of stroke-like symptoms as an emergency (OR, 4.58; 95% CI, 1.65-12.67). African-Americans were significantly more likely than Caucasians to call 911 (62% vs. 43%, P = .02).
  
  
  CONCLUSIONS
  African-Americans used 911 at a significantly higher rate. Use of 911 may be related to access to transportation, lack of insurance, or proximity to the hospital although this information was not available. Interventions are needed to improve patient arrival times to telemedicine equipped emergency departments after stroke.
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina. Electronic address: malek@musc.edu.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Malek
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Adams
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Ellen
authors.initials: E
authors.lastname: Debenham
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Boan
authors.affiliation: Department of Healthcare Leadership & Management, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Abby S
authors.initials: AS
authors.lastname: Kazley
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Hyacinth I
authors.initials: HI
authors.lastname: Hyacinth
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Jenifer H
authors.initials: JH
authors.lastname: Voeks
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Lackland
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001364:Awareness; D003937:Diagnosis, Differential; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D019114:Remote Consultation; D012959:Socioeconomic Factors; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy; D017216:Telemedicine; D013689:Telephone; D014481:United States; D044465:White People / Q000706:statistics & numerical data
keywords: 911; Stroke; emergency medical services; perception