Barr Jeanne, McKinley Sharon, O'Brien Elizabeth, Herkes Geoffrey
Royal North Shore Hospital, Sydney, Australia.
Neuroepidemiology. 2006;26(3):168-75. doi: 10.1159/000091659. Epub 2006 Feb 21.
Campaigns within Australia and internationally have sought to increase awareness of the emergent nature of stroke. For these initiatives to be effective it is important to gather information about delay in seeking treatment and the reasons given for the delay by people with stroke. The purpose of this study was to examine delay in seeking treatment in people with an evolving stroke or TIA and identify clinical, behavioral and demographic factors that contributed to the delay.
During a 1-year period 150 participants were given the Response to Stroke Symptoms Questionnaire. The six domains included in the questionnaire were: (1) context in which the stroke occurred; (2) antecedents to symptoms; (3) affective response to symptoms; (4) behavioral response to symptoms; (5) cognitive response to symptoms; (6) the response of others to patient symptoms.
The median delay time from symptom onset to admission to hospital was 4.5 h. While 41% of participants delayed less than 3 h, more than 45% delayed greater than 6 h. Independent predictors of delay time included mode of arrival at hospital with those taking an ambulance having a median delay time of 2.7 h vs. 15.4 h for those arriving by private car (p = 0.04). Gender also predicted delay with women delaying longer (p = 0.001). The first response of others was also an independent predictor of delay time (p = 0.003) with those who called the emergency services number or took the patient to hospital resulting in the shortest patient delays. Finally, if the patient appraised their symptoms as serious they had a shorter delay time (p = 0.02).
The message about the emergent nature of stroke may be helping to improve delay times. However, there are still many people who delay greater than 3 h after symptom onset. It is important to direct education programs to those with known risk factors for stroke and their families, who often make the decision to call an ambulance.
澳大利亚及国际上开展的相关活动致力于提高对中风紧急性的认识。为使这些举措行之有效，收集有关寻求治疗延迟的信息以及中风患者给出的延迟原因非常重要。本研究的目的是调查进展性中风或短暂性脑缺血发作（TIA）患者寻求治疗的延迟情况，并确定导致延迟的临床、行为和人口统计学因素。
在1年期间，150名参与者填写了中风症状反应问卷。问卷包含的六个领域为：（1）中风发生的背景；（2）症状的前驱因素；（3）对症状的情感反应；（4）对症状的行为反应；（5）对症状的认知反应；（6）他人对患者症状的反应。
从症状发作到入院的中位延迟时间为4.5小时。虽然41%的参与者延迟时间少于3小时，但超过45%的参与者延迟时间超过6小时。延迟时间的独立预测因素包括到达医院的方式，乘坐救护车的参与者中位延迟时间为2.7小时，而乘坐私家车到达的参与者中位延迟时间为15.4小时（p = 0.04）。性别也可预测延迟情况，女性延迟时间更长（p = 0.001）。他人的第一反应也是延迟时间的独立预测因素（p = 0.003），拨打急救服务电话或送患者去医院的情况导致患者延迟时间最短。最后，如果患者认为自己的症状严重，其延迟时间较短（p = 0.02）。
关于中风紧急性的信息可能有助于缩短延迟时间。然而，仍有许多人在症状发作后延迟超过3小时。将教育项目针对有中风已知危险因素的人群及其家属非常重要，因为他们通常会决定是否拨打救护车电话。
