Recognize Stroke Symptoms Research Articles

Stroke awareness in a Brazilian Northeastern capital city and the burden of the COVID-19 pandemic.

The delay in recognizing stroke symptoms is a significant obstacle to receiving acute treatment. Therefore, it is essential to understand the gaps in the knowledge about stroke among the general population and promote campaigns based on these gaps. To investigate the general knowledge about stroke in a capital in Northeastern Brazil in a sample of individuals who attended a public hospital and the impacts of the coronavirus disease 2019 (COVID-19) pandemic on the use of emergency services. We included patients older than 18 years of age and their family members and/or companions. After obtaining consent, the researcher presented a typical case of stroke, and the participants filled out a questionnaire divided into 2 sections: sociodemographic data and 15 questions about stroke detection and seeking health services and treatment. We included 154 individuals with a mean age of 44.45 ± 16.21 years. After presenting the case, 60.4% mentioned the acronym AVC (acidente vascular cerebral, or cerebrovascular accident [stroke], in Portuguese) as a possible explanation, and 54.5% reported that they would call the Mobile Emergency Care Service. However, 62.9% provided the incorrect telephone number for the Mobile Emergency Care Service or lacked knowledge of the accurate number. Regarding the risk factors for stroke, 27.9% did not know any of them, 65.5% were unaware of any treatment, and no reference was made to thrombolytic therapy. About their chosen conduct in the same case in the context of the COVID-19 pandemic, 98.1% of the participants would not change their behavior. These results can assist in the planning of public policies and campaigns emphasizing the issue of risk factors and how to access emergency medical services in the state of Alagoas, Brazil.

Post-Acute COVID-19 Syndrome and Stroke

This review explores the multifaceted strategies to mitigate the risk of cerebrovascular impairment in young adults recovering from COVID-19. The pandemic has illuminated an increased incidence of stroke in populations traditionally considered at lower risk, underscoring the need for targeted preventative measures. Given the complex interplay between SARS-CoV-2 infection and stroke risk, this article synthesizes current evidence and recommendations across lifestyle modifications, medical interventions, and proactive health monitoring. Key recommendations include adopting a heart-healthy diet, engaging in regular physical activity, and implementing stress reduction techniques. The management of existing cardiovascular risk factors, such as hypertension and diabetes, is emphasized as crucial for minimizing stroke risk post-COVID. Moreover, education on recognizing stroke symptoms is vital for ensuring timely medical response. The review also discusses the importance of avoiding smoking, limiting alcohol intake, and, for specific high-risk individuals, the judicious use of anticoagulants. Regular medical follow-ups for monitoring post-COVID symptoms and addressing any ongoing complications are advocated to identify and manage potential risks early. In conclusion, a comprehensive approach involving lifestyle changes, vigilant management of pre-existing conditions, education on stroke symptoms, and regular healthcare engagement is essential for reducing the risk of cerebrovascular events in young adults recovering from COVID-19. This review underscores the importance of continued research and public health advocacy in addressing the long-term effects of the pandemic on cerebrovascular health.

Mnemonic utilization in stroke education: FAST and BEFAST adoption by certified comprehensive stroke centers.

Symptom recognition and timely access to treatment are critical components of acute stroke care systems. Two mnemonics widely used in public educational campaigns for recognizing stroke symptoms include FAST (Face-Arm-Speech-Time) and BEFAST (Balance-Eyes-Face-Arm Speech-Time). The FAST mnemonic can miss up to 14% of strokes. BEFAST includes common posterior circulation stroke symptoms and has been implemented by several Comprehensive Stroke Centers (CSCs). We sought to analyze the pattern of public educational materials available on the websites of US CSCs. The Joint Commission (JC) quality check website compiles a list containing the names and locations of the country's 217 JC-certified CSCs, which was downloaded in August, 2022. Each CSC's website was searched for educational material containing FAST and BEFAST mnemonics for stroke symptom recognition. The FAST mnemonic was listed by 35% of CSCs, the BEFAST by 58%, with 7% listing no specific mnemonic. The highest portion of CSCs using BEFAST was in western (65%) and southeastern (63%) states. The highest percentage of CSCs with no listed mnemonic were in the northeastern (14%) and southeastern (13%) states. Consistency is critical in shaping public health education related to stroke symptoms recognition. Our study suggests further effort is needed to unify the public messaging on stroke recognition.

Comparison Between In‐Hospital and Community‐Onset Stroke Treated With Endovascular Thrombectomy: A Propensity Score–Matched Cohort Study

Background Patients with acute ischemic stroke onset during hospital admission often have concurrent illnesses, increased underlying comorbidities and are often associated with a delayed recognition of stroke onset, compared with patients with stroke onset in the community (community‐onset stroke [COS]). Endovascular thrombectomy (EVT) for large‐vessel occlusion in acute ischemic stroke has been proven to be effective, though the safety and feasibility of EVT among patients with in‐hospital stroke (IHS) onset remains undetermined. We aim to compare the workflow and clinical outcomes for patients undergoing EVT following IHS onset and COS. Methods Using data from a national stroke registry, we used propensity score‐matched individual‐level data of patients who underwent EVT, following IHS and COS, between October 2015 and March 2020. Univariate analysis was performed to assess the procedural, functional, and safety outcomes. Results We included 4353 patients (COS, 4104 [249 after propensity score matching]; IHS, 249 [249 after propensity score matching]). Compared with COS, patients with IHS had similar modified Rankin Scale on discharge (odds ratio [OR], 0.98 [95% CI, 0.72–1.34]; P =0.96) and at 6 months (OR, 1.25 [95% CI, 0.71–2.24]; P =0.48). No significant difference in achieving good functional outcome (modified Rankin Scale ≤ 2 at discharge; 31.3% [IHS] versus 29.3% [COS]; OR,=1.10 [95% CI 0.74–1.60]; P =0.61), successful reperfusion (modified Thrombolysis in Cerebral Infarction score of 2b–3), P =0.82; or safety outcomes of symptomatic intracranial hemorrhage ( P =0.64) and in‐hospital mortality ( P =0.26) were demonstrated. Shorter time interval from stroke onset to imaging in the IHS group (IHS, 80±88 versus COS, 216±292 minutes) was observed. The imaging‐to‐arterial‐puncture time was not significantly different between the groups (IHS, 160±140 versus COS, 162±184 minutes; P =0.85). Conclusions EVT in patients with IHS is safe and feasible, with comparable functional and safety outcomes to patients with COS, in this national stroke registry. Continued efforts are required to improve the inpatient stroke workflow in recognizing stroke symptoms and initiating reperfusion treatment for eligible patients with IHS.

Abstract Number ‐ 65: US Comprehensive Stroke Center Utilization of FAST and BEFAST Mnemonics for Public Education

Introduction Symptom recognition and timely access to treatment are critical components of acute stroke care systems. Two mnemonics widely used in public educational campaigns for recognizing stroke symptoms include FAST (Face‐Arm‐Speech‐Time) and BEFAST (Balance‐Eyes‐Face‐Arm Speech‐Time). The FAST mnemonic, endorsed by the AHA/ASA can miss up to 14% of strokes. BEFAST includes common posterior circulation stroke symptoms and has been implemented by several Comprehensive Stroke Centers (CSCs). Methods We sought to analyze the pattern of public educational materials available on the websites US CSCs. The Joint Commission (JC) quality check website compiles a list containing the names and locations of the country’s 217 JC‐certified CSCs, which was downloaded in August, 2022. Each CSC’s website was searched for educational material containing FAST and BEFAST mnemonics for stroke symptom recognition. Results The FAST mnemonic was listed by 35%of CSCs, the BEFAST by 58%, with 7% listing no specific mnemonic. The highest portion of CSCs using BEFAST was in western (65%) and southeastern (63%) states. The highest percentage of CSCs with no listed mnemonic were in the northeastern (14%) and southeastern (13%) states. Conclusions Consistency is critical in shaping public health education related to stroke symptoms. Our study suggests further effort is needed to unify the public messaging on stroke recognition.

Abstract TP56: Us Comprehensive Stroke Center Utilization Of FAST And BEFAST Mnemonics For Public Education

Introduction: Symptom recognition and timely access to treatment are critical components of acute stroke care systems. Two mnemonics widely used in public educational campaigns for recognizing stroke symptoms include FAST (Face-Arm-Speech-Time) and BEFAST (Balance-Eyes-Face-Arm Speech-Time). The FAST mnemonic, endorsed by the AHA/ASA can miss up to 14% of strokes. BEFAST includes common posterior circulation stroke symptoms and has been implemented by several Comprehensive Stroke Centers (CSCs). Methods: We sought to analyze the pattern of public educational materials available on the websites of US CSCs. The Joint Commission (JC) quality check website compiles a list containing the names and locations of the country’s 217 JC-certified CSCs, which was downloaded in August, 2022. Each CSC’s website was searched for educational material containing FAST and BEFAST mnemonics for stroke symptom recognition. Results: The FAST mnemonic was listed by 35% of CSCs, the BEFAST by 58%, with 7% listing no specific mnemonic. The highest portion of CSCs using BEFAST was in western (65%) and southeastern (63%) states. The highest percentage of CSCs with no listed mnemonic were in the northeastern (14%) and southeastern (13%) states. Conclusions: Consistency is critical in shaping public health education related to stroke symptoms recognition. Our study suggests further effort is needed to unify the public messaging on stroke recognition.

PS-P06-6: GENDER DIFFERENCES ON DETERMINANTS OF GOOD KNOWLEDGE ON RECOGNITION OF STROKE SYMPTOMS AND ACTIONS DURING A STROKE AMONG HYPERTENSIVE PATIENT

Early recognition and action during a stroke are extremely important to improve stroke prognosis. This study aimed to examine the gender difference in the KAP of stroke in hypertensive patients. This was a cross-sectional study conducted on adults 18 years and older who participated in a community blood pressure (BP) screening program in Malaysia during MMM2017. The questionnaire was derived based on the acronym F.A.S.T recommended by the American Stroke Association and two common symptoms of middle cerebral artery occlusion (paralysis of one side of the body and numbness or tingling sensation of one side of the body). Using multivariate logistic regression, the determinants of recognizing stroke symptoms and knowing what to do during a stroke in female and male hypertensive patients were identified. Among 1019 hypertensive patients, 85.% of women versus 84% of men were able to recognise symptoms of stroke (p = 0.564) but the prevalence of good knowledge of actions to be taken by being hospitalised within 4.5 hours during a stroke was 74% among women vs. 80% in men (p = 0.05). Using multivariate logistic regression, the determinants for recognising stroke symptoms among male hypertensive patients were age more than 45 year old(OR: 2.670,p = 0.016) compared with those aged below 45, symptom of body paralysis (OR: 9.37,p = 0.001) and symptom of numbness of the body(OR:6.177,p < 0.001);whereas in female hypertensive patient were symptoms of body paralysis (OR:26.582,p < 0.001), being Malay (OR:2.306, p = 0.034) vs. non-Malay and age more than 45 year old(OR:2.706,p = 0.024) compared to those under 45 years old. The determinants of good knowledge on actions to be taken during a stroke among male hypertensive patient were symptoms of body paralysis (OR:8.25,p = 0.031) compared to female respondents were symptom of body paralysis (OR:5.603,p < 0.001),symptom of slurred speech (OR:5.597,p = 0.003) and diastolic BP (OR:0.962, p = 0.005). Men know better what to do during a stroke. Symptoms of body paralysis was the most common stroke symptoms recognized by all hypertensive patients regardless in order to take further action. Clinicians need to be aware of these findings, and more action needs to be taken to educate female hypertensive patients about other stroke symptoms so that further action can be taken.

Awareness on Stroke Warning Signs and Risk Factors amongst Rural Population in Selangor

Stroke is a neurological disorder known to be the third leading cause of death in Malaysia. Eighty percent of the cases occurred due to abrupt blockage of blood supply to the brain causing the affected brain area to become damaged and lead to disability or even death [1]. The gold standard treatment via tissue plasminogen activator, however, is most effective to be administered within three hours after the onset of stroke symptoms [2]. According to previous report in 2020, most of the stroke patients that arrived late at the emergency medical care unit were due to the delay in deciding to seek medical attention following the stroke symptoms [3]. Lack of knowledge about the stroke risk factor, signs, and symptoms as well as the tendency of procrastination can result in delay in seeking medical treatment. Several studies had reported the poor level of understanding as well as awareness of stroke signs and symptoms among urban population in Malaysia [4,5]. Therefore, the objective of this cross-sectional study is to explore the awareness and action towards stroke symptoms and risk factors amongst rural population in Selangor, Malaysia.
 
 A cross- sectional questionnaire-based study via snowball sampling was conducted amongst the adult individuals residing in several districts of Hulu Selangor, Sabak Bernam and Kuala Selangor that are recognized as rural areas by the Selangor state council. The study used a set of developed questionnaires that consists of two sections: sociodemographic characteristics as well as the awareness and action towards stroke symptoms and risk factors. Descriptive analysis was used to express the variables.
 
 Of the 343 respondents, the mean ±SD for awareness on stroke symptoms was 3.9±1.82 out of a total score of 8 whereas awareness on stroke risk factors was 8.9±3.68 out of a total score of 13 (Table 1). The awareness about the stroke symptoms was considered poor as only 36.44% subjects were able to identify all five symptoms of stroke. Meanwhile only 32.4% of respondents were aware of all the risk factors for stroke despite all of them (100%) had heard about stroke. Although most of the respondents recognized stroke as an emergency condition, only 31.8% of them were aware of the appropriate action of calling an ambulance upon recognizing stroke symptoms (Table 2).
 Previous reports on awareness of stroke symptoms and risk factors were mostly conducted among urban population is Selangor. In 2014, a similar survey conducted among residents in Kajang reported that only 35% of the respondents had satisfactory knowledge of the stroke warning signs while 29% had satisfactory knowledge on the stroke risk factors. Although 78% can correctly recall Emergency Medical Systems number, only 11% were aware of calling the ambulance as the most appropriate action towards witnessing stroke symptoms in individuals [4]. On the other hand, a more recent study conducted among Petaling Jaya residents in 2019 reported that 82.9% to 92.1% of the respondents were able to recognize common symptoms of stroke followed by 74.2% of the study respondents saying that they would go to hospital within 4.5 hours of stroke onset [5].
 
 On contrary, the present study indicates a poor awareness and action towards stroke symptoms amongst rural population in Selangor. Thus, it is suggested that future intervention programs should focus on health promotion and awareness program related to cardiovascular diseases to the community living in the rural districts of Selangor.

Nurses knowledge, awareness and confidence level to recognize stroke symptoms specific to women: A cross-sectional study

Background: Stroke remains the third-leading cause of death and a major cause of disability in women. Men and women share common stroke symptoms. However, women can also experience “specific,” or “atypical” stroke symptoms. Early recognition of stroke and recognizing sex race-ethnic differences in stroke symptoms is crucial to better outcomes. Nurses play a crucial role in identifying stroke symptoms and activating care early. However, the general nurse’s knowledge and confidence level to recognize stroke in women is unknown. This study aimed to provide insight into nurse’s awareness, knowledge and confidence to recognize women's specific stroke symptoms.Methods: A cross-sectional study was conducted over four months. 129 nurses were recruited via targeted social media platforms to complete an online survey. Data were analyzed using descriptive statistics, independent t-tests, and one-way ANOVA.Results: Nurses were 86% women, and 55% held advanced degrees. Over 80% identified the common stroke symptoms; over 70% identified the additional stroke symptoms. Less than 25% could identify specific stroke symptoms in women. A majority of the nurses (76%) lacked the confidence to recognize stroke symptoms in women, with confidence scores statistically lower in advanced level trained nurses.Conclusions: The majority of nurses know and feel confident that they could identify the most common and additional stroke symptoms. However, there are knowledge deficits, and nurses lack confidence in recognizing stroke symptoms in women. Education targeted at nurses should include strategies to enhance their awareness, knowledge and confidence level in recognizing stroke symptoms specific to women.

Decision‐Making in Seeking Emergency Care for Stroke Symptoms

Background Previous studies have shown that rapid treatment for stroke, especially ischemic stroke, reduces mortality and disability. The focus has mainly been on reducing time from arrival at hospital to start of treatment. However, the main reason for delay is often time from symptom onset to arrival at hospital. This study therefore aimed to explore decision‐making processes after the onset of stroke symptoms in patients experiencing a first‐time stroke. Methods We included 36 patients aged 18 and older, all of whom were hospitalized with a first‐time stroke between October 2018 and April 2020. All patients were interviewed once within 4 weeks of symptom onset and before hospital discharge. Eligible patients were identified retrospectively through a targeted review of medical records. The data were collected and analyzed according to the grounded theory methodology. Results In total, 43 potential patients were identified and asked to participate. Overall, 36 patients were included in the study: 17 women (median age 77.0 years, interquartile range 17.5) and 19 men (median age 65.7 years, interquartile range 17.2). All interviewees felt fear, and this affected their decision to seek emergency care. The decision‐making processes were described by the core category of “Acting on fear.” The reason for feeling frightened determined the actions taken. The reasons were sorted into 3 main categories: (1) “seeking care”–recognized stroke symptoms and acted immediately; (2) “pending and reluctance”–suspected stroke but awaited to seek care; and (3) “seeking an explanation”–confused by symptoms. Conclusion We found that decision‐making when experiencing stroke symptoms was complex. All patients felt fear, which determined their actions. Some patients knew about stroke symptoms and acted immediately. Others suspected stroke but still chose to wait, whereas others were confused and tried to find answers. These results could contribute to form future awareness campaigns.

Pre-Hospital and In-Hospital Delay in Acute Ischemic Stroke Patients in Indonesia: A Multi-center Study

Introduction: Little is known regarding pre-hospital and in-hospital delays in acute ischemic stroke (AIS) patients in Indonesia. This study aimed to evaluate the nature of these delays and identify factors causing pre-hospital delays among AIS patients in Indonesia. Methods: This was a prospective, observational study conducted among adult AIS patients in 3 hospitals in Surabaya during March–August 2019. Baseline characteristics along with time intervals both pre- and post-arrival of patients to the study sites were collected and analysed. Multiple logistic regression analyses with a stepwise forward model were performed to evaluate the factors contributing to the pre-hospital delay. Results: A total of 126 patients were recruited in this study. Mean age ± S.D. was 58.56 ± 10.71 years old. The mean ± S.D. time of pre-hospital delay and mean ± S.D. time to computerized tomography scan were 1,004±1,116.09 and 189±166.44 minutes, respectively. Only 18 out of 126 patients (14.29%) presented to the hospitals within 4.5-hour of intravenous thrombolysis (IVT) time window. However, only 3 patients (2.38%) ultimately received IVT. Wake-up stroke (OR=17.865; p=0.019), unawareness of the gravity of symptoms (OR=11.025; p=0.007), unawareness of stroke symptoms (OR=7.880; p=0.003) and referral patient (OR=7.819; p=0.008) were significantly associated with pre-hospital delay. Conclusion: Pre-hospital delay of AIS was very common and represented a challenging problem to improve stroke care in Indonesia. Wake-up stroke along with lack of patient understanding in recognizing stroke symptoms and ineffective referral system were the most prominent risk factors for pre-hospital delay in Indonesian AIS patients.

Abstract NS8: Nurses Need Education On Women's Unique Stroke Symptoms

Background: Stroke remains the third-leading cause of death and a major cause of disability in women. After a stroke, women have a 59% disability rate compared to 26% for men in the acute phase. Men and women share common stroke symptoms. However, women can also experience “unique” “atypical,” or “nontraditional” stroke symptoms. Early recognition of stroke is crucial to better outcomes, but despite the fact that nurses play a crucial role in identifying stroke symptoms and activating care early, information is lacking on nurse’s knowledge in recognizing stroke symptoms in women. Purpose: To examine nurse’s knowledge and confidence level in recognizing common and unique stroke symptoms in women. Methods: In this quantitative study, nurses were recruited via targeted social media platforms to complete an online survey about women and stroke. Nurses self-declared that they met eligibility criteria. A nurse was defined as an individual who holds a license, is legally permitted to practice, and holds the title of Registered Nurse, Advanced Practice Nurse (masters or doctorate), or Licensed Practical Nurse. Data were analyzed using descriptive statistics, independent t -tests, and one-way ANOVA. Results: 129 nurses completed the survey over four months. Nurses were 86% women with a mean age of 42 years, and 55% held advanced degrees. Over 80% identified the common stroke symptoms of stroke, and over 70% identified the additional stroke symptoms. However, less than 25% could identify unique stroke symptoms of women, including difficulty breathing or shortness of breath (7%), hallucination (11%). A majority of the nurses (76%) lacked the confidence to recognize stroke symptoms in women. Lower scores for common stroke symptom knowledge ( p =0.01), confidence ( p =0.01), and unique stroke symptoms in women confidence scores ( p =0.05) were observed in nurses with < 20 years’ experience. Conclusions: Nurses lacked knowledge and confidence in correctly identifying unique stroke symptoms in women with nurses who had fewer years of professional experience fairing worse. Education targeted at nurses should include strategies to enhance their knowledge and confidence level in recognizing stroke symptoms unique to women.

Abstract 57: Seeking Support For Symptoms Of Stroke Delays Emergency Medical Service Activation For Thai Women And Men

Background: National stroke campaigns have been implemented to improve stroke knowledge and awareness for the Thai public. Despite these efforts, only a minority of people recognize stroke symptoms and seek treatments within 4.5 hours after symptom onset. Studies reveal sex differences in stroke knowledge, which contributes to delayed treatment-seeking actions. Purpose: This study aimed to examine sex differences in stroke knowledge, symptoms, stroke recognition, and initial action between men and women after experiencing acute strokes. Methods: A cross-sectional study was conducted at three hospitals in Thailand between September and November 2020. Medical record reviews and patient interviews were completed within seven days of admission. Standardized questionnaires for prior stroke knowledge (stroke warning signs & proper actions), clinical manifestation, stroke recognition, first action, and the activation of the emergency medical service (EMS) were used. Results: A total of 170 patients (54% men) with a median age of 63 years were included. Mean scores for prior stroke knowledge were higher in men compared to women (2.97 vs. 2.23, p = .02). Men were more likely than women to identify sudden numbness or weakness and sudden trouble walking or dizziness as stroke warning signs (62% vs. 42%, p = .01; 57% vs. 40%, p = .03, respectively). Women more frequently experienced severe headache (37% vs. 18%, p < .01). No significant differences between men and women were found in stroke recognition (20% vs. 26%) and activation of the EMS system (22% vs. 19%). Seeking support from someone nearby or on the phone was the most frequent first action in men (47%) and women (55%), which often delayed EMS activation. Conclusion: Even though men scored higher in stroke knowledge than women, challenges to activating the EMS were found in both sexes, highlighting the need to explore targeted educational material and knowledge translation among high-risk stroke patients and their relatives, regardless of sex.

Association Between Dispatch Complaint and Critical Prehospital Time Intervals in Suspected Stroke 911 Activations in the National Emergency Medical Services Information System, 2012–2016

ObjectiveEmergency Medical Services can help improve stroke outcomes by recognizing stroke symptoms, establishing response priority for 911 calls, and minimizing prehospital delays. This study examines 911 stroke events and evaluates associations between events dispatched as stroke and critical EMS time intervals. Materials and methodsData from the National Emergency Medical Services Information System, 2012 to 2016, were analyzed. Activations from 911 calls with a primary or secondary provider impression of stroke were included for adult patients transported to a hospital destination. Three prehospital time intervals were evaluated: (1) response time (RT) ≤8 min, (2) on-scene time (OST) ≤15 min, and (3) transport time (TT) ≤12 min. Associations between stroke dispatch complaint and prehospital time intervals were assessed using multivariate regression to estimate adjusted risk ratios (ARR) and 95% confidence intervals (CIs). ResultsApproximately 37% of stroke dispatch complaints were identified by EMS as a suspected stroke. Compared to stroke events without a stroke dispatch complaint, median OST was shorter for events with a stroke dispatch (16 min vs. 14 min, respectively). In adjusted analyses, events dispatched as stroke were more likely to meet the EMS time benchmark for OST ≤15 min (OST, 1.20 [1.20–1.21]), but not RT or TT (RT, [1.00–1.01]; TT, 0.95 [0.94–0.95]). ConclusionsOur results indicate that dispatcher recognition of stroke symptoms reduces the time spent on-scene by EMS personnel. These findings can inform future EMS stroke education and quality improvement efforts to emphasize dispatcher recognition of stroke signs and symptoms, as EMS dispatchers play a crucial role in optimizing the prehospital response.

Hemorrhagic stroke: a diagnosis guided by visual field findings

This case report outlines a patient with a hemorrhagic stroke who presented to the eye clinic with visual field loss, which the patient interpreted as blur, and a severe headache. The visual field loss consisted of an incomplete homonymous hemianopsia with an absolute superior defect, which corresponds well to the right sided temporal lobe hemorrhage found on head computed tomography (CT) scan. This case highlights the importance of all eye care providers recognizing stroke symptoms and understanding referral timelines and protocols as well as the high predictive value of visual fields.

Baseline Stroke Literacy of Young Children Based on "FAST 112 Heroes" Program.

Background: Young children are often unaware of emergency health conditions, such as stroke, and could serve as important vehicles to save the lives of their grandparents, who are more likely to suffer a stroke. An important aspect for the evaluation of public awareness on stroke signs and related emergency procedures is to examine the level of baseline stroke knowledge children have and whether they understand when to seek medical care on time.Objective: To examine the level of stroke symptomatology knowledge in children as well as evaluate their preparedness in stroke response before their participation in the educational program “FAST (Face, Arms, Speech, Time) 112 Heroes.”Methods: For the purpose of this work, a questionnaire was developed and adapted to preschoolers' needs. The present study involved 123 children (65 boys, 58 girls, aged 4–6.5 years; mean age: 5.30, S.D.: 0.59) from two cities in Greece. Five multiple-choice animated pictures, that were age-appropriate, were administrated to each child, along with verbal explanations provided by the investigator.Results: More than half of the participants (n = 65, 52.8%) could recognize the symptom of face drooping, 53 children (43.1%) could identify the symptom of arm hemiparesis/hemiplegia and 92 children (74.8%) were able to answer the question regarding speech disturbances. However, the number of correct answers to the question regarding the appropriate course of action in case of a stroke was the lowest among all the questions (10.6% of participants gave a correct answer). Furthermore gender and age did not play a significant role (p = 0.571 and 0.635, respectively).Conclusion: Although more than half of the enrolled preschool children could recognize stroke symptoms before their participation in the educational program, their baseline stroke knowledge, prior to their training, is low. Concurrently, they do not have sufficient knowledge on how to react appropriately in the event of a stroke. Therefore, awareness programs focusing on developing stroke literacy to children are needed, to ensure children will seek urgent medical care in case of a stroke.

Abstract MP6: Thrombolysis for Acute Wake-Up And Unclear Onset Strokes With Alteplase at 0.6mg /kg in Clinical Practice: THAWS2 Study

Background and Purpose: IV alteplase at 0.6 mg/kg for acute wake-up and unclear onset strokes was recommended in Japanese stroke guidelines in March 2019. We determined the safety and effectiveness of this newly recommended thrombolysis in clinical practice. Methods: This is a multicenter observational study, enrolling acute ischemic stroke patients with a time last-known-well >4.5 h who have a mismatch between DWI and FLAIR treated with intravenous alteplase. The safety outcomes are intracranial hemorrhage (ICH) with neurological deterioration within 36 h after thrombolysis, all cause deaths within 90 days, and adverse events. The efficacy outcomes are functionally independence defined as a mRS score of 0-1 at 90 days, and NIHSS change at 24h from baseline. Results: Between 2019 March and 2020 March, 63 patients (33 females; age, 74±11y; premorbid functionally independence, 50 (82%); median NIHSS on admission, 11) were enrolled at 14 hospitals. Of them, 40 patients (63%) recognized stroke symptoms at wake-up time, and median time between last-known-well and admission was 6.5 h. Baseline MRA showed any vessel occlusion in 52 patients (88%). IV alteplase was disrupted in one patient. Two patients (3%) had symptomatic ICH (≥4 increase in NIHSS) within 36 h. NIHSS change was -5.1±8.1. Twenty-one patients (36%) had functionally independence at discharge and there was no death during acute hospitalization. Of the overall 63 patients, 22 also underwent mechanical thrombectomy (36%, 72±9y, median NIHSS 16), showing no symptomatic ICH, mean NIHSS change of -8.9±7.5, and 8 patients (42%) had functionally independence at discharge. Conclusions: In clinical practice, IV alteplase for wake-up and unclear onset stroke patients with DWI-FLAIR mismatch seemed to be safe and effective compared with previous randomized control trials. Mechanical thrombectomy could be combined with alteplase safely and effectively.

Abstract P286: The Effects of COVID-19 on the Reasons for Not Calling 911 for Acute Stroke

Objective: Our Stroke Program regularly provides community outreach and stroke education. The stroke team educates on signs and symptoms of stroke, risks factors, and 911 activation. Within a few days of discharge, Neuroscience nurses call stroke patients to ensure patients have obtained their prescription medications, have follow-up appointments, inquire about their satisfaction with our services, and reinforce stroke education. As part of these calls, our team asked why patients/families did not call 911. The purpose of this study was to determine if the COVID-19 crisis influenced the reasons why 911 was not called for possible stroke to better plan for targeted stroke education. Method: Discharge phone survey data from our stroke network was collected from Feb-Jul 2019 and compared to Feb-Jul 2020. Our stroke network includes 1 comprehensive stroke center and 2 primary stroke centers. Emergency Department (ED) stroke activation data was gathered for the same time periods. Discharge phone calls data was based on discharge date, whereas ED stroke alert data was based on admission date. Results: There was a notable decline in stroke volume between 2019 to 2020 with the largest decline occurring during the first peak (Apr 2020) in COVID-19 cases within our state. This decline was driven by a 16% decline in walk-in ED stroke arrivals as compared to a 1% decline in EMS stroke arrivals. Of those who did not call 911 in 2020, there was a 7% increase in failing to recognize stroke symptoms as an emergency, a 6% increase in concern about EMS cost, and 6% decrease in hospital preference. Conclusion: The COVID-19 crisis negatively influenced stroke volumes within our system stroke program. Reductions in stroke walk-ins accounted for this decline. COVID-19 affected the reasons why 911 was not called. The largest increase was in not recognizing stroke symptoms as an emergency and increased concern about EMS associated costs. Surprisingly, COVID-19 was not listed as a reasons for avoiding 911. Targeted community educational efforts on these concerns may lead to improved 911 usage for suspected stroke during the COVID-19 pandemic. Limitations: Further research is needed to investigate why those with a stroke who would have been walk-ins decided not to seek urgent medical attention.

Make Kids Stroke-Smart: A Community Based Interventional Study.

Background: Stroke is the third leading cause of death and the major cause of long-term disability in the United States. Timely recognition of symptoms is critical. Family members are crucial in recognizing stroke symptoms since <5% patients can call Emergency Medical Services themselves due to inability to speak or dial the phone. This might be of significance, especially, in family units where children have frequent contact with multiple generations. This study was undertaken to assess and improve the knowledge about stroke amongst children.Methods: A community-based interventional study was conducted among 305 kids ranging from second to eighth grade. A pre-test questionnaire was administered and later health education regarding stroke was imparted using audiovisual aids. Post-test was done to assess the impact of stroke education. Components of education included were: 1) What is stroke? 2) FAST mnemonic. 3) Time sensitive treatment. 4) Risk factors for stroke 5) How can they help? 6) Whom to call and where to go? The data was compiled and analyzed using Chi square test.Results: There was a significant lack of knowledge in the pretest groups. The post-test showed statistically significant improvement in all the tested components irrespective of age or grade (p<0.001).Conclusion: Targeting the younger generation for stroke education is one way to improve community knowledge of stroke symptoms thus increasing the chances that the stroke patient may receive acute stroke therapy. Children can also be used as a conduit to transmit educational information to parents and other family members thus further raising awareness.

Factors Associated with Delay of Emergency Medical Services Activation in Patients with Acute Stroke

BackgroundThe poor prognosis of acute stroke may be largely attributed to delays in treatment. Emergency medical services (EMS) usage is associated with a significant reduction in the delay in stroke treatment. The aims of this study were to identify factors associated with the delay in EMS activation for patients with acute stroke. MethodsThis study was conducted at 26 Fire Safety Centers in five districts of Seoul, Korea. Patients with acute stroke transferred by EMS and admitted to a tertiary referral hospital from January 2014 to December 2018 were enrolled. In this cross-sectional study, the dependent variable was the time from stroke onset to EMS activation time. Patients were divided into two groups, onset-to-alarm time ≤ 30 min and onset-to-alarm time > 30 min, and previously collected patient data were analyzed. We performed logistical regression analyses of characteristics differing significantly between groups. ResultsOut of 480 patients, 197 (41%) had onset-to-alarm times > 30 min. Significant variables in the logistical analysis were alert mental state (adjusted odds ratio [aOR]: 2.77; 95% confidence interval [CI]: 1.31–6.13), pre-stroke mRS ≥ 2 (aOR: 2.46; 95% CI: 1.26–4.95), onset occurrence at private space (aOR: 2.31; 95% CI: 1.23–4.41), recognizing symptoms between 0 and 8 am (aOR: 2.30; 95% CI: 1.25–4.31), ischemic stroke (aOR: 1.88; 95% CI: 1.04–3.43), and witnessed by others (aOR: 0.32; 95% CI: 0.18–0.55). ConclusionsDelay in EMS activation for acute stroke cases is possibly related to difficult situations to recognize stroke symptoms, such as alert mental state, pre-stroke mRS ≥ 2, onset occurrence at private space, recognizing symptoms between 0 and 8 am, and unwitnessed by others.