Early Stroke Symptoms Research Articles

Methods for Detecting Early Symptoms of Stroke: A Literature Review

Background: In the world every 2 seconds 1 person suffers from a stroke, and 16% of the world's population experiences a stroke in their lifetime, every 4 seconds 1 person dies. The initial symptoms of a stroke must be recognized quickly until the stroke patient's golden period of 4.5 hours is over so that there is no wider damage to brain tissue due to a lack of oxygen for too long which causes brain cells (neurons) to die and connections or connections between neurons (synapses) to be lost. can cause paralysis, blurred vision, difficulty speaking, decreased consciousness and even death. Objectives: To analyze the Early Symptom Detection Method of Stroke. Methods: The authors conducted a PRISMA-style systematic review of Stroke Early Symptom Detection Methods in various countries. Using five articles that were used and then included for analysis and interpretation. Results: There are two methods for early detection of early symptoms of stroke that can be used to detect early symptoms of stroke, namely F.A.S.T and BE-FAST. Both methods have the same accuracy and have an optimal limit for detecting stroke of ≥1. Conclusion: There are two methods for early detection of early symptoms of stroke that can be used to detect early symptoms of stroke, namely F.A.S.T and BE-FAST, for this reason these methods need to be disseminated to the public. So it has the impact of being able to increase knowledge about stroke symptom detection which can increase timely stroke detection before the golden period ends.

Knowledge and awareness of stroke in the United Arab Emirates: a cross-sectional study of the general population.

The study aimed to assess stroke knowledge among the general population in the United Arab Emirates (UAE) and determine the factors associated with stroke awareness among people. A cross-sectional study was conducted in the UAE between September and November 2021. The general population has self-administered an online bilingual survey (Arabic and English) distributed via social media platforms. The questionnaire covered general knowledge about stroke risk factors, consequences of stroke, and responding to somebody with acute stroke attack. A total of 545 surveys were completed, with more than half of the participants being female (58.5%), married (55.4%) and employed (59.4%). The majority were less than 50 years old (90.5%) and had a university degree (71.0%). Many of the participants (70.8%) had a good general knowledge of stroke; however, around 20% of the participants were able to recognize all symptoms and risk factors of stroke. The most common sources of stroke-related information were the internet/social media (53.6%). Females were better able to correctly identify at least one stroke symptom and outcome than males (p=0.008). University education has significantly affected participants' ability to identify early stroke symptoms (p=0.001) correctly. In addition, diabetic people were more likely to recognize at least one stroke outcome than non-diabetic people (p=0.039). The knowledge of stroke was good among highly educated people and females. However, the awareness of all stroke risk factors, symptoms, consequences and risk factors was inadequate among the general population of the UAE. Thus, there is still a gap between recognition of the relevant stroke and taking action among people.

Public knowledge of early stroke symptoms in the Vilnius region

Background and aim. Stroke remains one of the most common causes of death and disability in the world. The evident decline in disabling outcomes can be attributed to the increasing use of reperfusion therapies. Stroke recognition and urgent admission of patients to specialized stroke centres after the onset of first stroke symptoms are essential for treatment outcomes. This study aims to assess public stroke awareness and its change since 2019.Methods. An anonymous cross-sectional study involving 300 Vilnius residents was conducted in 2022, the results of which were compared with the data of 502 respondents in 2019. A closed-ended questionnaire was used for the study. Statistical analysis was performed using IBM SPSS software with p<0.05 significance level.Results. Stroke was identified as an acute cerebrovascular disorder by 83.3% of respondents in 2022 (82.7% in 2019). At least one correct warning sign of stroke was indicated by 98.7% of respondents (96.4% in 2019). The most commonly mentioned symptoms of stroke were one-sided face, arm or leg sensory disturbances, paralysis, or weakness (90.0%) and speech disorder (83.3%), with 82.1% and 81.5% respectively in 2019. Only 58% (45.4% in 2019) of respondents reported visual impairment as a stroke symptom. Women had better knowledge of stroke than men (p<0.05). The internet was the main source of information for 63.3% of respondents (64.9% in 2019).Conclusions. Since 2019, stroke awareness has improved in Vilnius. This proves that F.A.S.T. campaign has reached the public. Women have better knowledge of stroke than men. Visual impairment is the least known symptom of stroke. Therefore, the search for new information programmes, especially directed to the targeted audience, can be useful for better publicity.

Knowledge and awareness of stroke in the United Arab Emirates: a cross-sectional study of the general population

Background: The study aimed to assess stroke knowledge among the general population in the United Arab Emirates (UAE) and determine the factors associated with stroke awareness among people. Methods: A cross-sectional study was conducted in the UAE between September and November 2021. The general population has self-administered an online bilingual survey (Arabic and English) distributed via social media platforms. The questionnaire covered general knowledge about stroke risk factors, consequences of stroke, and responding to somebody with acute stroke attack. Results: A total of 545 surveys were completed, with more than half of the participants being female (58.5%), married (55.4%) and employed (59.4%). The majority were less than 50 years old (90.5%) and had a university degree (71.0%). Many of the participants (70.8%) had a good general knowledge of stroke; however, around 20% of the participants were able to recognize all symptoms and risk factors of stroke. The most common sources of stroke-related information were the internet/social media (53.6%). Females were better able to correctly identify at least one stroke symptom and outcome than males (p=0.008). University education has significantly affected participants' ability to identify early stroke symptoms (p=0.001) correctly. In addition, diabetic people were more likely to recognize at least one stroke outcome than non-diabetic people (p=0.039). Conclusions: The knowledge of stroke was good among highly educated people and females. However, the awareness of all stroke risk factors, symptoms, consequences and risk factors was inadequate among the general population of the UAE. Thus, there is still a gap between recognition of the relevant stroke and taking action among people.

Public stroke awareness among Gharbia governorate inhabitants: a cross-sectional study

BackgroundStroke is the most common acquired neurological disease in the adult population worldwide with an incidence of 16 million new cases every year responsible for about 6.1 million deaths and 130.6 million disability-adjusted life-years (DALYs). The objectives of this work were to study the level of stroke awareness and the proper response for suspected stroke patients in urban and rural areas of Tanta City, Egypt. The study was conducted on 1869 Egyptian Citizens; 908 and 961 reside in urban and rural areas, respectively, who were submitted to a face-to-face interview using the stroke awareness questionnaire (Arabic version).ResultsRural participants showed a significant reduction in acute cerebrovascular stroke (CVS) awareness and knowledge including the most affected organ by CVS, what are the risk factors, what are the early stroke symptoms, is there specific treatment for acute ischemic stroke, and what is the proper reaction when confronted with a case of acute CVS?ConclusionUrban populations have better recognition of stroke risk factors, early stroke symptoms, and the proper response when confronted with a case of acute CVS when compared with rural people possibly due to better socioeconomic status and higher educational levels.

Factors associated with knowledge and awareness of stroke among the Lebanese population: A cross-sectional study.

Background: Evaluation of the knowledge about stroke in the general population is extremely vital as it prevents stroke development, limits complications, and achieves better quality of life. We assume that the general Lebanese population lacks awareness about stroke and its associated complications. This study aims to evaluate stroke knowledge and determine the factors associated with stroke awareness among the general Lebanese population. Methods: This cross-sectional study assessed respondents' sociodemographic characteristics and the identification of risk factors, warning signs, stroke consequences, and early response to stroke symptoms. A total of 551 Lebanese adults without a history of stroke filled in an online self-reported questionnaire publicly shared on social applications. Logistic regression analysis was performed to identify the factors associated with poor knowledge of stroke. Results: Among the 551 participants enrolled, 403 (74.2%) were females and 312 (56.7%) were under 30 years of age. Females compared to males and employed compared to unemployed had significantly higher odds of identifying at least one risk factor (OR=4.3 [95%CI=1.1;16.8] and 6 [95%CI=1.2;29.6], respectively). Also, when compared to unemployed, employed participants had significantly higher odds of recognizing at least one of the early stroke symptoms (OR=3.3 [95%CI=1.2;8.9]) and identifying at least one of the stroke consequences (OR=5.3 [95%CI=1.1;25.9]). Reaching a university level of education compared to a school level was associated with significantly higher odds (OR=2.3 [95%CI=1.1;4.8]) of taking a patient to a hospital. Conclusion: Well-educated, employed, and female participants were more knowledgeable about stroke. Tailored interventions focusing on individuals with inadequate stroke literacy are needed. Further studies, more representative of the general Lebanese population with a larger sample size, are necessary to confirm our findings.

Using Multiple Logistic Regression to Determine Factors Affecting Delaying Hospital Arrival of Patients with Acute Ischemic Stroke.

Early treatment of ischemic stroke patients who arrive at the hospital ≤4.5 hours after the onset of symptoms with recombinant tissue plasminogen activator is more beneficial and very important. This study is aimed to investigate the factors delaying the hospital arrival of patients with acute ischemic stroke by using multiple logistic regression analysis. This descriptive cross-sectional study was done on patients diagnosed with acute ischemic stroke who were referred to Ardabil city Training and Research hospital at 2018. All patients and/or patient relatives were interviewed and data were collected through a checklist including demographic and clinical data of patients to explore the involved factors delaying hospital arrival of patients and then analyzed using multiple logistic regression analysis. Of all included patients, only 25.3% arrived at the hospital in ≤ 4.5 hours. By using multivariate logistic regression analysis, living in cities (P = 0.007), cigarette consumption (P = 0.032), having valvular heart disease (P = 0.008), and gender (P = 0.049) were factors associated with an early arrival to the hospital. Results showed that most of the patients had a considerable delay in arriving at the hospital in ≤ 4.5 hours. Thus, providing health promotion strategies to improve society awareness of early symptoms of stroke, training of local physicians about the importance of early arrival of stroke patients, and more extended ambulance services in all cities and rural areas are necessary for better management of acute stroke patients in this area.

Factors associated with knowledge and awareness of stroke among the Lebanese population: A cross-sectional study

Background: Evaluation of the knowledge about stroke in the general population is extremely vital as it prevents stroke development, limits complications, and achieves better quality of life. We assume that the general Lebanese population lacks awareness about stroke and its associated complications. This study aims to evaluate stroke knowledge and determine the factors associated with stroke awareness among the general Lebanese population. Methods: This cross-sectional study assessed respondents’ sociodemographic characteristics and the identification of risk factors, warning signs, stroke consequences, and early response to stroke symptoms. A total of 551 Lebanese adults without a history of stroke filled in an online self-reported questionnaire publicly shared on social applications. Logistic regression analysis was performed to identify the factors associated with poor knowledge of stroke. Results: Among the 551 participants enrolled, 403 (74.2%) were females and 312 (56.7%) were under 30 years of age. Females compared to males and employed compared to unemployed had significantly higher odds of identifying at least one risk factor (OR=4.3 [95%CI=1.1;16.8] and 6 [95%CI=1.2;29.6], respectively). Also, when compared to unemployed, employed participants had significantly higher odds of recognizing at least one of the early stroke symptoms (OR=3.3 [95%CI=1.2;8.9]) and identifying at least one of the stroke consequences (OR=5.3 [95%CI=1.1;25.9]). Reaching a university level of education compared to a school level was associated with significantly higher odds (OR=2.3 [95%CI=1.1;4.8]) of taking a patient to a hospital. Conclusion: Well-educated, employed, and female participants were more knowledgeable about stroke. Tailored interventions focusing on individuals with inadequate stroke literacy are needed. Further studies, more representative of the general Lebanese population with a larger sample size, are necessary to confirm our findings.

Factors associated with knowledge and awareness of stroke among the Lebanese population: A cross-sectional study.

Background: Evaluation of the knowledge about stroke in the general population is extremely vital as it prevents stroke development, limits complications, and achieves better quality of life. We assume that the general Lebanese population lacks awareness about stroke and its associated complications. This study aims to evaluate stroke knowledge and determine the factors associated with stroke awareness among the general Lebanese population. Methods: This cross-sectional study assessed respondents' sociodemographic characteristics and the identification of risk factors, warning signs, stroke consequences, and early response to stroke symptoms. A total of 551 Lebanese adults without a history of stroke filled in an online self-reported questionnaire publicly shared on social applications. Logistic regression analysis was performed to identify the factors associated with poor knowledge of stroke. Results: Among the 551 participants enrolled, 403 (74.2%) were females and 312 (56.7%) were under 30 years of age. Females compared to males and employed compared to unemployed had significantly higher odds of identifying at least one risk factor (OR=4.3 [95%CI=1.1;16.8] and 6 [95%CI=1.2;29.6], respectively). Also, when compared to unemployed, employed participants had significantly higher odds of recognizing at least one of the early stroke symptoms (OR=3.3 [95%CI=1.2;8.9]) and identifying at least one of the stroke consequences (OR=5.3 [95%CI=1.1;25.9]). Reaching a university level of education compared to a school level was associated with significantly higher odds (OR=2.3 [95%CI=1.1;4.8]) of taking a patient to a hospital. Conclusion: Well-educated, employed, and female participants were more knowledgeable about stroke. Tailored interventions focusing on individuals with inadequate stroke literacy are needed. Further studies, more representative of the general Lebanese population with a larger sample size, are necessary to confirm our findings.

Construction of a Health Management Model for Early Identification of Ischaemic Stroke in Cloud Computing.

Knowledge discovery and cloud computing can help early identification of ischaemic stroke and provide intelligent, humane, and preventive healthcare services for patients at high risk of stroke. This study proposes constructing a health management model for early identification and warning of ischaemic stroke based on IoT and cloud computing, and discusses its connotation, constructive ideas, and research content so as to provide reference for its health management in order to develop and implement countermeasures and to compare the awareness of early stroke symptoms and first aid knowledge among stroke patients and their families before and after the activity. The rate of awareness of early symptoms and first aid among stroke patients and their families increased from 36% to 78%, and the difference was statistically significant (P < 0.05) before and after the activity.

Abstract 1122‐000134: Social and Cultural Barriers to Global Stroke Care

Introduction : Comprehensive stroke centers require resource‐intensive patient care and supportive divisions. Resource underutilization can include: traditional beliefs about etiology of stroke, transportation barriers, or an inability to recognize early symptoms of stroke. We explore the available literature to determine region‐specific social and cultural barriers to obtaining stroke care. Methods : A literature review was performed to identify studies that described stroke care in low‐income and middle‐income countries (LMICs). We used the search term “stroke” along with the following terms: “burden”, “incidence”, “prevalence”, “awareness”, “transportation”, “stroke services”, “rehabilitation” “tissue plasminogen activator”, “acute stroke”, “emergency care”, “infrastructure”, “stroke services”, “quality improvement”, and “stroke units”, between January 1st, 2015 and August 1st, 2021. Forty‐five articles were identified. Results : We identified two broad limitations to expanding stroke care across the globe: infrastructure and education/ culture. We subdivided stroke care regionally into Middle East and North Africa (MENA), Europe, Asia, Latin America, and Subsaharan Africa. In MENA, religious health fatalism scores on questionnaires are negatively correlated with adherence to rehabilitative protocols and stroke outcome. Increased faith engagement conversely is strongly correlated with improved psychiatric outcome following stroke, indicating a role in properly educating Middle Eastern citizens regarding stroke etiology and urgency of treatment. In Europe stroke mortality and incidence is greater in rural areas in the region, likely indicating transit‐related difficulties in obtaining stroke care or deficits in education regarding lifestyle‐based measures to reduce vascular disease. Low per capita numbers of stroke‐specific care units in southern and eastern countries indicate a significant care access need in rural and low‐resource regions. For Asia, a lack of major infrastructure obstacles to wider accessibility of EVT, especially among developing countries. Only 6.5% in a nationwide survey in China were aware that there was a therapeutic window for thrombolytic therapy in 2016, increased to 32.8% after a 2 year nationwide campaign. The adept use of social media to target high‐risk populations can improve awareness of therapeutic windows. Ethnic and socioeconomic disparities are especially pronounced in this region. The RESILIENT trial demonstrated the effectiveness of EVT in Brazilian public hospitals, which helped convince the government to change policy and promote the use of EVT. Similar trials could be used to convince other governments to shift policy and promote the use of EVT as standard of care in public hospital systems. Some African communities consider stroke to be an illness of debilitating/ paralytic, ghost, or shivering etiology. Many communities rely on non medical means of care. A survey at Ignance Deen Neurology ward in 2014 revealed that only 2% of stroke patients arrived in an ambulance while 46% came by public transport and 27% arrived by personal car. Conclusions : Social and cultural barriers to obtaining stroke care are based on lack of availability and patient trust. Trust in care and compliance with preventive/rehabilitative measures may be helped by connecting NGOs such as Stroke Angels and Mission Thrombectomy 2020 with community‐based/ religious leaders to correct assumptions about origin and treatment. Targeted, culturally‐relevant messaging may help to increase awareness about symptoms, risk factors, and etiology.

Expert System for Diagnosing Early Symptoms of Stroke Using the Fuzzy Mamdani Method

One of the dangerous diseases is stroke because it can disrupt the nervous system system in humans so that sufferers of this disease often experience paralysis in their body parts. Therefore, an application is needed to assist medical personnel when doctors are not available or are not on duty. Expert system applications are needed in early diagnosing the characteristics of the disease suffered by a patient. Expert systems are computer-based systems that use knowledge, facts and reasoning techniques to solve problems. The purpose of this study is to make it easier for researchers to identify problems with stroke based on the symptoms experienced by the patient or a person. The research method used is the fuzzy mamdani method. Data collection techniques are quantitative data techniques. The results that have been achieved from this study are that it can prevent and reduce the risk of stroke that can occur as early as possible in sufferers or the community and reduce the death rate in stroke patients.

Factors Associated with Unawareness of Early Symptoms of Stroke and Myocardial Infarction in Adults with Hypertension and Diabetes: Focused on Management related to Disease

Factors Associated with Unawareness of Early Symptoms of Stroke and Myocardial Infarction in Adults with Hypertension and Diabetes: Focused on Management related to Disease

Hubungan Pengetahuan Keluarga dan Perilaku Keluarga pada Penanganan Awal Kejadian Stroke

Introduction: Early intervention of stroke would be reduced mortality and risk of disability. Early intervention was supported by the knowledge of risk factors and early symptoms of stroke. This study was aimed to determine the relationship between family knowledge and behavior in the initial treatment of stroke events. Methods: This study used a correlational descriptive design with cross-sectional approach. The researchers employed a non-probability sampling i.e. accidental sampling. The study was conducted at a hospital in Semarang in May 2019. The respondents were 77 families of patients during the stroke. The knowledge tool used the Stroke Recognition Questionnaire (SRQ) consisting of 30 questions and a behavioral questionnaire involving nine questions. Data analysis used Spearman Rank. Results: The result of bivariate analysis indicates there is a correlation between family knowledge and behavior with the value P = 0.000 and r = 0.83. Conclusion: The study concluded there was a correlation between knowledge and behavior. Correlation between the two variables was strong and indicated the positive direction of correlation which the higher of knowledge influenced the better of Family behavior. Nursing interventions needs to be developed to increase knowledge about the risk factors and early symptoms of stroke and management at home at the stroke outbreak.

‘Fast'- negative presentation of stroke patients in Alain Hospital - UAE, 2017–2018

Recognizing early symptoms of stroke is vital for proper diagnosis and management. Traditionally, ‘FAST’ (Facial drooping, Arm weakness, Speech difficulty and Time to call emergency)presentation has been used to achieve this. But what if the initial presentation of a stroke patient was ‘FAST’-negative? Here we assessed the extent of ‘FAST'-negative presentations in Al Ain Hospital (AAH). AAH Stroke registry of 2017 and 2018 were reviewed. We selected patients with initial presentation of ‘FAST'-negative who had ischemic stroke (IS), transient ischemic attack (TIA) and hemorrhagic stroke (HS). Gender, nationality, stroke subtype, and presenting symptoms were evaluated. Then we classified the results based on the most common symptom at presentation. Symptoms were categorized into the 10 most common presentations. Total number of patients was 107; which included 80 males and 27 females. Composed of 37% Asian, 29% Emirati and 34% Arab. 77 had IS, 22 had HS and 8 had TIA. Following analysis of the onset symptom; 10 presentations were frequently repeated (Figure 1). Although some of the symptoms may overlap; only the 1st reported presentation was considered. They included, respectively; dizziness, headache, confusion/altered mental status, loss of consciousness (LOC), seizure, visual disturbance, lethargic/fatigue and disorientation/memory disturbance. The obtained results reflect that there are different symptoms reported by patients as the initial presentation of stroke other than ‘FAST’. The 2 most common symptoms are dizziness /vertigo and headache. This should alert physicians to consider stroke in atypical presentations and increase their suspicion in high risk population.

Factors delaying hospital arrival of patients with acute stroke.

Background:Low rates of thrombolysis for ischemic stroke in India and other developing countries have been attributed to delays in presentation to the hospital.Materials and Methods:A prospective study was carried out during a 12-month period ending December 2012 in the department of Neurology, Malabar Institute of Medical Sciences, Kerala, India, to look for the factors contributing to delay in hospital arrival of patients with acute stroke. Patients and or their relatives were interviewed within 48 hours of admission using a structured questionnaire.Results:A total of 264 patients attending the emergency department were included. There were 170 men and 94 women. The mean age was 61.5 ± 12.4 years. A total of 67 (25%) patients presented within 4 hours of stroke onset. Factors associated with early arrival (multivariate logistic regression analysis) were distance 15 km or less from hospital (P 0.03, odds ratio (OR) 2.7), directly reaching the stroke department (P < 0.001, OR 9.7), history of coronary artery disease (P 0.001, OR 3.84), higher educational status (P 0.001, OR 3.7), and presence of hemiplegia (P 0.001, OR 5.5).Conclusions:We found a considerable delay in the early arrival of patients to our stroke department. Health promotion strategies to improve community awareness of early symptoms of stroke, education of local physicians about the importance of early referrals to the stroke centers, and wider availability and use of ambulance services are promising methods to help expedite presentation to hospital post stroke and thereby improve the management of stroke in India.

Effects of Intensive and Moderate Public Education on Knowledge of Early Stroke Symptoms Among a Japanese Population

To assess the effects of intensive and moderate public education on knowledge of early stroke symptoms among a general Japanese population. Information on early stroke symptoms was distributed by leaflet 12× and by booklet twice in an intensive intervention area >22 months, and by leaflet and booklet once each in a moderate intervention area. No distribution occurred in the control area. Before and after the intervention, a mailed survey was conducted in the 3 areas. A total of 2734 individuals, aged 40 to 74 years, who did not select all 5 correct symptoms of stroke in the preintervention survey were eligible for our analysis. The numbers of correct answers selected about stroke symptoms did not differ significantly among the 3 areas in the preintervention survey (P=0.156). In the postintervention survey, the proportions of participants who selected sudden 1-sided numbness or weakness (94.2% in the intensive intervention area, 88.3% in the moderate intervention area, and 89.2% in the control area; P<0.001) and sudden severe headache (76.8%, 70.1%, and 70.4%, respectively; P<0.001) differed significantly among the 3 areas. After adjustment for confounding factors, the multivariable-adjusted odds ratios (95% confidence intervals) for correctly choosing all 5 symptoms were 1.35 (1.07-1.71) in the intensive intervention area and 0.96 (0.74-1.24) in the moderate intervention area compared with the control area. Our findings suggest that frequent distribution of leaflets and booklets significantly improved the short-term knowledge of community residents about early symptoms of stroke.

응급구급대원에서 뇌졸중 조기증상 인지 및 환자평가 향상을 위한 교육 필요성

Results: The results showed that 63.2% of those surveyed had completed the required educational programs on stroke during the past year. The level of awareness about early symptoms of stroke and assessment of stroke patients' condition was relatively high for women, those who were 30 years under, low position people, emergency service practitioners, emergency medical technicians, and people who have completed education, respectively. It was also turned out that 82.8% of those surveyed took stroke patients to the nearest hospitals first so that they could receive appropriate treatment. The level of awareness about early symptoms of stroke and assessment of stroke patients' condition in people who have completed education were higher than non-complete. The level of awareness about early symptoms of stroke was positively correlated with confidence, satisfaction and appropriateness in treatment of stroke patients. Conclusions: These results strongly suggest that it is necessary to operate specialized educational programs to enhance EMTs' appropriate awareness of the early symptoms of stroke and assessment of stroke patient's condition.

Effects of comprehensive education protocol in decreasing pre-hospital stroke delay among Chinese urban community population

Background and purpose: Studies have shown that awareness of early stroke symptoms and the use of ambulances are two important factors in decreasing pre-hospital stroke delay. The purpose of this study is to evaluate a comprehensive educational stroke protocol in improving stroke response times.Method: Two urban communities in Beijing (population ≈50 000), matched in economic status and geography, were enrolled in this study. A comprehensive educational protocol, which included public lectures and distribution of instructive material for the community and its medical staff, was implemented from August 2008 to December 2010. Surveillance of new onset stroke in both communities was carried out during the same period. Pre-hospital delay time and percentage of patients using emergency medical services (EMS) were compared between the two communities.Results: After comprehensive educational protocol, we found that: (i) pre-hospital delay (time from stroke symptom onset to hospital arrival) decreased from 180 to 79 minutes, (ii) the proportion of patients arriving within three hours of stroke onset increased from 55·8% to 80·4%, (iii) pre-hospital delay of stroke patients with symptoms of paralysis, numbness, and speech impediments was decreased, and (iv) the proportion of stroke patients calling for EMS increased from 50·4% to 60·7%.Conclusion: The comprehensive educational stroke protocol was significantly effective in decreasing pre-hospital stroke delay.

Factors Associated With Prehospital Delays in the Presentation of Acute Stroke in Urban China

Low rates of thrombolysis for ischemic stroke in China have mainly been attributed to delays in presentation to the hospital. This study aimed to evaluate factors associated with these delays. Data were from a prospective, multicenter, hospital-based registry of patients with acute stroke (ChinaQUEST [Quality Evaluation of Stroke Care and Treatment]), which involved 62 hospitals across a variety of economic and geographic regions in China during 2006. Univariate and multivariate analyses were undertaken to determine associations between variables of interest and delays to hospital presentation. Median time to hospital presentation was 15.0 hours for 6102 cases (interquartile range, 2.8-51.0 hours). A total of 1546 (25%) patients arrived within 3 hours and 2244 (37%) patients arrived within 6 hours after symptom onset. Factors that prolonged time to presentation were: visiting a local doctor before presenting at emergency (OR, 0.48; P<0.001), symptom onset at home (OR, 0.62; P<0.001), transfer to a large (Level III) hospital for management (OR, 0.70; P=0.04), and history of diabetes (OR, 0.78; P=0.01). In contrast, factors that accelerated presentation to the hospital were hemorrhagic stroke (OR, 2.25; P<0.001), history of atrial fibrillation (OR, 1.94; P<0.001), unconsciousness at presentation (OR, 1.91; P<0.001), transfer by ambulance (OR, 1.91; P<0.001), and history of coronary artery disease (OR, 1.20; P=0.04). Health promotion strategies to improve community awareness of early symptoms of stroke, establishment of an alert system to cater for patients likely to experience stroke at home, and wider availability and use of ambulance services are promising methods to help expedite presentation to hospital poststroke and thereby improve the management of stroke in China.