title: Patient behaviour at the time of stroke onset: a cross-sectional survey of patient response to stroke symptoms.
abstract: OBJECTIVE
  Revascularisation treatment with thrombolysis must be initiated within 4.5 h following ischaemic stroke symptom onset. Despite its proven benefits, thrombolysis therapy is underused, with patient delay in presenting to hospital with symptoms identified as the leading barrier. This study aimed to examine help-seeking behaviour at stroke onset, in order to understand delays in accessing acute medical care for stroke symptoms.
  
  
  METHODS
  149 consecutive patients hospitalised with ischaemic stroke were interviewed at 72 h poststroke with the Stroke Awareness Questionnaire and the Response to Symptoms Questionnaire.
  
  
  RESULTS
  Sixty per cent of stroke cases presented to the ED within 3.5 h of stroke onset. Knowledge of stroke symptoms and risk factors was poor, with 40% unable to correctly define a stroke. Bystander recognition of symptoms (p=0.03) and bystander initiation of Emergency Medical Services was associated with ED presentation within 3.5 h (p=0.03).
  
  
  CONCLUSIONS
  This study provides insights into patient response when a stroke occurs, with the presence and action of others highlighted as critical in fast response to stroke symptoms. Knowledge of stroke warning signs and risk factors was low among stroke survivors. Findings highlight the complexity of changing help-seeking behaviour during stroke onset, and provide directions for public education efforts to reduce prehospital delay.
authors.affiliation: Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: L
authors.initials: L
authors.lastname: Mellon
authors.affiliation: Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: F
authors.initials: F
authors.lastname: Doyle
authors.affiliation: Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Williams
authors.affiliation: Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: L
authors.initials: L
authors.lastname: Brewer
authors.affiliation: Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Hall
authors.affiliation: Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Hickey
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007494:Ireland; D008297:Male; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment
keywords: education; neurology, stroke; pre-hospital; stroke; thrombolysis