Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ - CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
Cerebrovasc Dis. 2012;34(2):161-8. doi: 10.1159/000341408. Epub 2012 Aug 17.
Worldwide thrombolysis rates remain suboptimal. Ambulance transfer is associated with greater use of this time-dependent treatment. Information on public awareness of stroke symptoms is important for planning effective education programs to promote calling of emergency services for suspected stroke. However, there is a paucity of data on this subject in European countries. Our objectives were to explore the recognition of stroke symptoms, awareness of the need to activate the emergency medical services for acute stroke events, and the association between knowledge of warning symptoms and intent to call for an ambulance among a sample representative of the adult population of Spain. This is the largest study on this subject to date in Europe.
The data were taken from the Study on Nutrition and Cardiovascular Risk in Spain, a cross-sectional study conducted in a sample representative of the Spanish noninstitutionalized population aged ≥18 years in 2008-2010. Study participants were selected by multistage clustered random sampling. The households within each section were selected by random telephone dialing using the landline telephone directory as the sampling frame. Subjects in the households were selected proportionally to the distribution of the population of Spain by sex and age. The study included a computer-assisted telephone interview on stroke symptom knowledge and the first action to perform in a stroke event, based on the American Heart Association and American Stroke Association recommendations, and two home visits to perform a physical examination and to obtain blood samples.
Among 11,827 adults, 7,711 (65.2%; 95% CI = 64.1-66.3) identified 4-6 stroke warning symptoms, considered as adequate knowledge. A total of 1,348 (11.4%) were unable to classify any of the symptoms correctly. In the multivariate analysis, higher education was significantly associated with better knowledge of symptoms, and age ≥65 years, fair/poor self-rated health, history of obesity and known diabetes were significantly associated with less knowledge of stroke symptoms. One in 5 individuals indicated they would do something other than calling for an ambulance if they thought someone was having a stroke. The number of specific stroke warning symptoms known was directly associated with the intent to call an ambulance in a stroke event (OR adjusted for sociodemographic and clinical variables = 1.06 per symptom, 95% CI = 1.03-1.09; p < 0.001).
In this population-based study, stroke symptom knowledge was suboptimal and only modestly associated with the intent to call for an ambulance. Educational interventions are needed to link stroke recognition more strongly to an immediate need to call for an ambulance in order to increase stroke patients' access to thrombolysis.
全球范围内的溶栓治疗率仍然不理想。救护车转运与更广泛使用这种时间依赖性治疗方法有关。了解公众对中风症状的认识，对于规划有效的教育计划以促进对疑似中风患者拨打急救服务电话至关重要。然而，在欧洲国家，关于这方面的数据非常有限。我们的目的是探讨西班牙成年人样本对中风症状的识别、对急性中风事件激活紧急医疗服务的意识，以及对预警症状的了解与拨打救护车意愿之间的关系。这是迄今为止欧洲在这一主题上最大的研究。
数据来自 2008-2010 年在西班牙非住院人口中进行的一项具有代表性的横断面研究，即西班牙营养与心血管风险研究。研究参与者通过多阶段聚类随机抽样选择。每个部分内的家庭通过使用固定电话簿的随机电话拨号选择。家庭中的受试者按西班牙人口的性别和年龄分布进行比例选择。该研究包括基于美国心脏协会和美国中风协会建议的中风症状知识和中风事件中应采取的第一行动的计算机辅助电话访谈，以及两次家访进行体检和采集血液样本。
在 11827 名成年人中，7711 名（65.2%；95%CI=64.1-66.3）识别出 4-6 种中风预警症状，被认为是足够的知识。共有 1348 名（11.4%）无法正确分类任何症状。在多变量分析中，较高的教育水平与更好的症状知识显著相关，而年龄≥65 岁、自我评估健康状况一般/较差、肥胖史和已知糖尿病与中风症状知识较差显著相关。五分之一的人表示，如果他们认为有人中风，他们会采取除拨打救护车以外的其他措施。知道的具体中风预警症状数量与中风事件中拨打救护车的意愿直接相关（调整社会人口统计学和临床变量后的比值比=每个症状 1.06，95%CI=1.03-1.09；p<0.001）。
在这项基于人群的研究中，中风症状知识不足，与拨打救护车的意愿仅略有相关。需要进行教育干预，将中风识别与立即拨打救护车的需求更紧密地联系起来，以增加中风患者获得溶栓治疗的机会。
