Mellor Ruth M, Bailey Sheila, Sheppard James, Carr Peter, Quinn Tom, Boyal Amunpreet, Sandler David, Sims Don G, Mant Jonathan, Greenfield Sheila, McManus Richard J
NHS Lanarkshire, Bothwell, UK.
Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
Ann Emerg Med. 2015 Mar;65(3):279-287.e3. doi: 10.1016/j.annemergmed.2014.10.018. Epub 2014 Nov 15.
We examine acute stroke patients' decisions and delays en route to the hospital after onset of symptoms.
This was a qualitative study carried out in the West Midlands, United Kingdom. Semistructured interviews were conducted with 30 patients (6 accompanied by partners). Patients were asked about their previous experience of having had a stroke and their initial engagement with health services. "One sheet of paper" and thematic analyses were used.
Three potential types of delay were identified from onset of symptoms to accessing stroke care in the hospital: primary delays caused by lack of recognition of symptoms or not dealing with symptoms immediately, secondary delays caused by initial contact with nonemergency services, and tertiary delays in which health service providers did not interpret the patients' presenting symptoms as suggestive of stroke. The main factors determining the speed of action by patients were the presence and influence of a bystander and the perceived seriousness of symptoms.
Despite campaigns to increase public awareness of stroke symptoms, the behavior of both patients and health service providers apparently led to delays in the recognition of and response to stroke symptoms, potentially reducing access to optimum and timely acute specialist assessment and treatment for acute stroke.
我们研究急性中风患者在症状发作后前往医院途中的决策和延误情况。
这是一项在英国西米德兰兹郡进行的定性研究。对30名患者（其中6名有伴侣陪同）进行了半结构化访谈。询问患者既往中风经历以及他们最初与医疗服务机构的接触情况。采用“单页纸”和主题分析法。
从症状发作到在医院接受中风治疗，确定了三种潜在的延误类型：因未识别症状或未立即处理症状导致的原发性延误、因最初接触非紧急服务导致的继发性延误，以及医疗服务提供者未将患者出现的症状解读为中风迹象导致的三级延误。决定患者行动速度的主要因素是旁观者的在场和影响以及对症状严重程度的感知。
尽管开展了提高公众对中风症状认识的活动，但患者和医疗服务提供者的行为显然导致了对中风症状的识别和反应出现延误，可能减少了急性中风患者获得最佳和及时的急性专科评估及治疗的机会。
