title: Do elderly patients call 911 when presented with clinical scenarios suggestive of acute stroke? A cross-sectional study.
abstract: OBJECTIVE
  Among patients with acute stroke symptoms, delay in hospital admission is the main obstacle for the use of thrombolytic therapy and other interventions associated with decreased mortality and disability. The primary aim of this study was to assess whether an elderly clinical population correctly endorsed the response to call for emergency services when presented with signs and symptoms of stroke using a standardized questionnaire.
  
  
  METHODS
  We performed a cross-sectional study among elderly out-patients (≥60 years) in Buenos Aires, Argentina randomly recruited from a government funded health clinic. The correct endorsement of intention to call 911 was assessed with the Stroke Action Test and the cut-off point was set at ≥75%. Knowledge of stroke and clinical and socio-demographic indicators were also collected and evaluated as predictors of correct endorsement using logistic regression.
  
  
  RESULTS
  Among 367 elderly adults, 14% correctly endorsed intention to call 911. Presented with the most typical signs and symptoms, only 65% reported that they would call an ambulance. Amaurosis Fugax was the symptom for which was called the least (15%). On average, the correct response was chosen only 37% of the time. Compared to lower levels of education, higher levels were associated to correctly endorsed intention to call 911 (secondary School adjusted OR 3.53, 95% CI 1.59-7.86 and Tertiary/University adjusted OR 3.04, 95% CI 1.12-8.21).
  
  
  CONCLUSIONS
  These results suggest the need to provide interventions that are specifically designed to increase awareness of potential stroke signs and symptoms and appropriate subsequent clinical actions.
authors.affiliation: Department of Internal Medicine, Hospital Dr. César Milstein associated with University of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Diego
authors.initials: D
authors.lastname: Caruso
authors.forename: Manuel
authors.initials: M
authors.lastname: Perez Akly
authors.forename: Pablo Daniel
authors.initials: PD
authors.lastname: Costantini
authors.forename: Sebastian
authors.initials: S
authors.lastname: Fridman
authors.forename: Maria Martha
authors.initials: MM
authors.lastname: Esnaola
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020757:Amaurosis Fugax; D000552:Ambulances / Q000706:statistics & numerical data; D001118:Argentina; D003430:Cross-Sectional Studies; D004522:Educational Status; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D020521:Stroke