Department of Clinical Medicine and Preventive Medicine, Danube University, Krems, Austria.
Int J Stroke. 2010 Jun;5(3):187-208. doi: 10.1111/j.1747-4949.2010.00428.x.
Time is essential for the treatment of acute stroke. Much time is lost outside the hospital, either due to failure in identifying stroke symptoms or due to a delay in notification or transport. We review studies reporting factors associated with better stroke knowledge and shorter time delays. We summarise the evidences for the effect of stroke knowledge and education on people's reaction in the acute situation of stroke.
We searched MEDLINE for studies reporting factors associated with prehospital time of stroke patients, or knowledge of stroke symptoms. Further, we searched for studies reporting educational interventions aimed at increasing stroke symptom knowledge in the population.
We included a total of 182 studies. Surprisingly, those factors associated with better stroke knowledge such as education and sociodemographic variables were not related to shorter time delays. Few studies report shorter time delays or better stroke knowledge in persons having suffered a previous stroke. Factors associated with shorter time delays were more severe stroke and symptoms regarded as serious, but not better knowledge about the most frequent symptoms such as hemiparesis or disorders of speech. Only 25-56% of patients recognised their own symptoms as stroke. While stroke education increases the knowledge of warning signs, a few population studies measured the impact of education on time delays; in such studies, time delays decreased after education. This may partly be mediated by better organisation of EMS and hospitals.
There is a discrepancy between theoretical stroke knowledge and the reaction in an acute situation. Help-seeking behaviour is more dependent on the perceived severity of symptoms than on symptom knowledge. Bystanders play an important role in the decision to call for help and should be included in stroke education. Education is effective and should be culturally adapted and presented in a social context. It is unclear which educational concept is best suited to enhance symptom recognition in the acute situation of stroke, especially in view of discrepancies between knowledge and action.
时间对于急性中风的治疗至关重要。由于未能识别中风症状，或者由于通知或转运延误，很多时间都在医院外流失。我们回顾了报告与更好的中风知识和更短的延迟时间相关因素的研究。我们总结了中风知识和教育对人们在中风急性情况下反应的影响证据。
我们在 MEDLINE 上搜索了报告与中风患者院前时间或中风症状知识相关因素的研究。此外，我们还搜索了旨在提高人群中风症状知识的教育干预措施的研究。
我们共纳入了 182 项研究。令人惊讶的是，与更好的中风知识相关的因素，如教育和社会人口变量，与更短的延迟时间无关。少数研究报告了有过中风史的人时间更短或中风知识更好。与更短的延迟时间相关的因素是更严重的中风和被视为严重的症状，但不是更频繁的症状，如偏瘫或言语障碍的知识更好。只有 25-56%的患者将自己的症状识别为中风。虽然中风教育增加了对警告信号的认识，但少数人群研究测量了教育对延迟时间的影响；在这些研究中，教育后延迟时间减少。这可能部分是通过更好地组织 EMS 和医院来实现的。
理论上的中风知识与急性情况下的反应之间存在差距。寻求帮助的行为更多地取决于症状的感知严重程度，而不是症状知识。旁观者在决定呼救方面发挥着重要作用，应将其纳入中风教育中。教育是有效的，应适应文化并在社会背景下呈现。尚不清楚哪种教育概念最适合提高中风急性情况下的症状识别能力，特别是考虑到知识和行动之间的差异。
