Abstract
BackgroundThe English National Stroke Strategy suggests that there is a need to improve the response of patients and witnesses to the symptoms of acute stroke to increase rapid access to specialist care. We wished to review the evidence base regarding the knowledge, attitudes and behaviours of stroke patients, witnesses and the public to the symptoms of stroke and the need for an urgent response at the onset of symptoms.MethodsWe conducted a systematic review of UK articles reporting empirical research on a) awareness of and response to the symptoms of acute stroke or TIA, and b) beliefs and attitudes about diagnosis, early treatment and consequences of acute stroke or TIA. Nine electronic databases were searched using a robust search strategy. Citations and abstracts were screened independently by two reviewers. Data were extracted by two researchers independently using agreed criteria.Results11 studies out of 7144 citations met the inclusion criteria. Methods of data collection included: postal survey (n = 2); interview survey (n = 6); review of hospital documentation (n = 2) and qualitative interviews (n = 1). Limited data reveal a good level of knowledge of the two commonest stroke symptoms (unilateral weakness and speech disturbance), and of the need for an emergency response among the general public and at risk patients. Despite this, less than half of patients recognised they had suffered a stroke. Symptom recognition did not reduce time to presentation. For the majority, the first point of contact for medical assistance was a general practitioner.ConclusionsThere is an assumption that, in the UK, public knowledge of the symptoms of stroke and of the need for an emergency response is lacking, but there is little published research to support this. Public awareness raising campaigns to improve response to the symptoms of stroke therefore may not produce an increase in desired behaviours. Further research is needed to understand why people who experience or witness stroke symptoms frequently do not call emergency services.
Highlights
The English National Stroke Strategy suggests that there is a need to improve the response of patients and witnesses to the symptoms of acute stroke to increase rapid access to specialist care
This review demonstrates that from the limited data identified there is a good level of knowledge of the two commonest stroke symptoms and of the need for an emergency response among the general public and at risk patients
Campaigns to increase awareness of stroke symptoms are based on the assumption that public knowledge is lacking about the common symptoms of stroke and the need for an emergency response
Summary
The English National Stroke Strategy suggests that there is a need to improve the response of patients and witnesses to the symptoms of acute stroke to increase rapid access to specialist care. Rapid access to a specialist service can reduce the risk of death and disability following stroke as early assessment enables accurate diagnosis, provision of acute treatment, early detection and response to complications, and provision of care by a multi-disciplinary team with expertise in stroke[3,4]. The strategy outlines 20 quality markers with the first stating that ‘members of the public and health and care staff are able to recognise and identify the main symptoms of stroke and know it needs to be treated as a medical emergency’[5].
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