Reasons of delay of hospital presentation in patients with acute stroke

ABSTRACT

BACKGROUND: Recent advances have been made in the treatment of acute stroke, but the effectiveness of the new therapies is highly time dependent. Patients with acute stroke often arrive at the hospital too late to receive the maximum benefit from these new stroke therapies. Efforts to reduce delay time of therapy for acute stroke may be more effective if the factors that delay hospital arrival are identified and targeted for specific intervention. So we studied about reason of delay of hospital presentation in patients with acute stroke. METHODS: The 85 acute stroke patients group who admitted to the Young-dong severance hospital from April to August 1999 were enrolled in this study. We collected clinical data from the medical record, including demographic characteristics, date and time of symptom onset, date and time of presentation to the hospital, medical history, and symptoms at stroke onset. And informants about stroke, method of transportation, the patient's interpretation of the symptoms were interviewed. We defined early arrival as within 3 hours of awareness of symptoms. RESULTS: The 85 patient were interviewed, early arrival were more likely to arrive by ambulance(P<0.001), admit via emergency department(P=0.001), interpret their symptoms as a stroke(P=0.005) and use readings as a informants about stroke(P=0.027) than late arrivals. Also they were younger than late arrivals(P=0.027). Main reason of delay of hospital presentation was because they expect spontaneous improvement(43%), mistake as other disease(23.3%), arrive via other medical institute(20%). CONCLUSION: Late arrivals expected spontaneous improvement, misinterpreted their symptoms as those of other disease and didn't choose proper medical institute for acute management. Considerable education is needed to increase the knowledge about stroke and proper acute management.