Hong Kong patients' knowledge of stroke does not influence time-to-hospital presentation

doi:10.1054/jocn.2000.0805

Journal of Clinical Neuroscience

Volume 8, Issue 4, July 2001, Pages 311-314

https://doi.org/10.1054/jocn.2000.0805 Get rights and content

Abstract

A prospective interview of consecutive patients admitted with acute stroke was conducted over an 8-week period to study the influence of patients' knowledge of stroke on time to presentation in Hong Kong. Early arrival was defined as within 6h of symptom onset. The patients' general knowledge of stroke was fair, and early arrival was seen in 40 (56.3%) of 71 patients. Early presentation was associated with male sex (P= 0.028) and a lower initial Glasgow coma scale score (P= 0.072), but not with age, a better general knowledge of stroke, a previous history of stroke or transient ischaemic attack, Rankin score upon discharge, and level of education. On the other hand, late presentation was associated with a belief in permanent disability (P= 0.056). Thus, improving the general knowledge of stroke among Hong Kong people may not reduce delay in hospital presentation of stroke patients.

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Delays in the diagnosis of ischaemic stroke presenting with persistent reduced level of consciousness: A systematic review
2023, Journal of Clinical Neuroscience
Stroke presenting with a reduced level of consciousness (RLOC) may result in diagnostic error and/or delay. Missed or delayed diagnosis of acute ischaemic stroke may preclude otherwise applicable hyperacute stroke interventions. The frequency, reasons for, and consequences of diagnostic error and delay due to RLOC are uncertain.
The databases PubMed, EMBASE, and Cochrane library were searched in adherence with the PRISMA guidelines. The systematic review was prospectively registered on PROSPERO.
Initial searches returned 1162 results, of which 6 fulfilled inclusion criteria. The majority of identified studies show that ischaemic stroke presenting with RLOC is at increased risk of missed or delayed diagnosis. Hyperacute stroke interventions may also be delayed. There is limited evidence regarding the reason for these delays; however, the delays may result from neuroimaging delay associated with diagnostic uncertainty. There is also limited evidence regarding the outcomes of patients with stroke and RLOC who experience diagnostic delay; however, the available literature suggests that outcomes may be poor, including motor and cognitive impairment, as well as long-term impaired consciousness. The included studies did not evaluate, but have suggested urgent MRI access, educational interventions, and protocolisation of the evaluation of RLOC as means to reduce poor outcomes.
Ischaemic stroke patients with RLOC are at risk of diagnostic delay and error. These patients may have poor outcomes. Additional research is required to identify the contributing factors more clearly and to provide amelioration strategies.
Stroke-Related Knowledge and Lifestyle Behavior among Stroke Survivors
2019, Journal of Stroke and Cerebrovascular Diseases
Citation Excerpt :
In the study by Slark et al16 45% of the patients did not acknowledge that having a previous stroke predisposed to future cardiovascular disease. It is reassuring that 93% of respondents correctly stated the appropriate action of notifying the EMS if suspected stroke, despite it being shown in previous studies that improved knowledge does not necessarily result in appropriate action when stroke is suspected.17,18 Smoking was the best-known risk factor, mentioned by 78%, and diabetes by 54%, corresponding well with the 75% and 48% in a previous survey.10
Aims: Awareness of stroke symptoms and risk factors, and actions taken in order to reduce the risk of new stroke events, should be of great importance among stroke survivors. The aims of this study were to assess changes in stroke-related knowledge and lifestyle behavior among patients experiencing a cerebrovascular event, and to assess the agreement between the patients’ self-reported diagnosis, and the discharge diagnosis. Methods: All patients discharged with a diagnosis of stroke or transient ischemic attack during a 1-year period, received postal survey questionnaires at 3 and 12 months after discharge. The questionnaires included questions about symptom knowledge, lifestyle behavior, and patients were asked to report on their diagnosis. Results: A total of 282 patients were included (mean age 71.8 years, 57.1% men). Self-reported symptom knowledge was increased at 3 months (P < .001), and this persisted at 12 months. There was a poor correlation (r = .082; P = .171) between increasing symptom knowledge and stated lifestyle behavior changes. In all, 63% of the respondents correctly identified their own cerebrovascular subtype. Thirty-seven percent had quit smoking after 12 months, 30% reported that they used less sugary items, and 26% used less fatty food after the cerebrovascular event. Conclusions: Stroke survivors reported increased stroke symptoms knowledge after 3 and 12 months. A proportion of patients made changes in lifestyle behavior. Only 2 out of 3 patients correctly identified their own cerebrovascular subtype, indicating room for improvement in clinical practice when informing and communicating with stroke and transient ischemic attack patients about their diagnosis.
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Analysis of gender differences in knowledge of stroke warning signs
2015, Journal of Stroke and Cerebrovascular Diseases
Citation Excerpt :
In fact, some studies indicate that women have longer prehospital delays.28,29 Further, knowledge of stroke symptoms does not consistently translate into earlier arrivals.10,11 For women, to decrease prehospital delays and reduce the risk of long-term disability, further research should investigate other reasons for prehospital delays.
The impact of gender on knowledge of stroke warning signs and preparedness is poorly understood, and gender-specific factors associated with poor knowledge of stroke warning signs have not been identified.
This was a cross-sectional study of 132,604 participants in the 2009 Behavioral Risk Factor Surveillance System Survey, a national telephone survey. Adults aged 18 years or older who lived in one of 19 states that administered an optional stroke module asking them to correctly identify stroke symptoms and the correct action to take were included. The primary outcome was a low score (≤4 of 7) on the Stroke Symptoms Knowledge Scale (SSKS). Logistic regression was performed for the overall sample and then stratified by gender, with adjustments made for age, race, Hispanic ethnicity, income, and whether respondents had a primary doctor (PMD). Data were weighted as recommended by the Centers for Disease Control.
In all, 51.7% of the weighted sample was women. Less women than men had low scores on the SSKS (21% versus 25%, P < .001). After adjusting for age, race, ethnicity, income, and PMD, men had higher odds of having low scores (adjusted odds ratio, 1.36; 95% confidence interval, 1.28-1.45). After stratifying by gender, Hispanic ethnicity, and age younger than 35 years predicted low scores on the scale in women but not in men.
Female gender is associated with better knowledge of stroke warning signs, but a gender-specific approach identified Hispanic women, young women, and black participants as subgroups at risk for having poor knowledge, suggesting the need for targeted stroke education to increase stroke preparedness in these groups.
Time interval between stroke onset and hospital arrival in acute ischemic stroke patients in Shanghai, China
2011, Clinical Neurology and Neurosurgery
Citation Excerpt :
Around one-third (30.2%, 162 patients) of all our patients arrived at hospital <3 h after the onset of acute ischemic stroke, and <6 h for a little more than half of the patients (51.9%, 278 patients). Our results were similar to that in a study from Hong Kong [4], in which 56.3% of the patients arrived at hospital within 6 h after the first symptom of stroke. Results from other Asian areas were various.
To observe the time interval between stroke onset and hospital arrival (time-to-hospital) in acute ischemic stroke patients and analyze its putatively associated factors.
During the period from November 1, 2006 to August 31, 2008, patients with acute ischemic stroke admitted consecutively to the Department of Neurology, Ninth Hospital, Shanghai, were enrolled in the study. Information of the patients was registered including the time-to-hospital, demographic data, history of stroke, season at attack, neurological symptom at onset, etc. Characteristics of the patients were analyzed and logistic regression analyses were conducted to identify factors associated with the time-to-hospital.
There were 536 patients in the study, 290 (54.1%) males and 246 (45.9%) females. The median time-to-hospital was 8 h (ranged from 0.1 to 300 h) for all patients. Within 3 h after the onset of stroke, 162 patients (30.2%) arrived at our hospital; and within 6 h, 278 patients (51.9%). Patients with a history of stroke, unconsciousness at onset, or a high NIHSS score at admission had significantly less time-to-hospital.
The time interval between stroke onset and hospital arrival was <6 h for around half of our patients with acute cerebral ischemic stroke. A history of stroke and severe symptoms at onset were significantly associated with shorter time-to-hospital. The results might indicate that the knowledge of stroke and understanding the importance of seeking immediate medical help after stroke onset of patients and their relatives could significantly influence their actions.

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^f1: Correspondence to: Dr Raymond T. F. Cheung, Tel.: + 852 2855 3315; Fax: + 852 2974 1171

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Regular ArticleHong Kong patients' knowledge of stroke does not influence time-to-hospital presentation

Abstract

Lancet

N Engl J Med

Guidelines for thrombolytic therapy for acute stroke. A supplement to the guidelines for the management of patients with acute ischemic stroke

Stroke

Neurology

GV 150526: An overview of phase II studies in stroke patients

Stroke

Stroke

Thrombolysis for stroke: pushed out of the window?

Br J Clin Pharmacol

Regular Article
Hong Kong patients' knowledge of stroke does not influence time-to-hospital presentation