Feldmann E, Gordon N, Brooks J M, Brass L M, Fayad P B, Sawaya K L, Nazareno F, Levine S R
Department of Clinical Neurosciences, Brown University School of Medicine, Providence, RI.
Stroke. 1993 Dec;24(12):1805-10. doi: 10.1161/01.str.24.12.1805.
Patients with stroke symptoms commonly delay many hours before seeking medical attention. We sought to explore the factors associated with early presentation of stroke patients to physicians.
We prospectively studied 100 consecutive acute stroke patients presenting to three large, urban medical centers. Using a standardized, structured interview and chart review, we assessed patient education about stroke, risk factors, clinical features of the stroke, source of stroke recognition, and timing of presentation. We did not study the distance from the site of stroke onset to the site of physician contact.
Stroke onset time was known in 96 of the patients. Mean patient age was 71.3 years, 79% had at least one stroke risk factor, 26% had prior transient ischemic attack, 19% had prior stroke, 74% had some high school education, and 86% had regular physicians. Only 8% had been previously educated about stroke symptoms. Eighty one percent of strokes were ischemic. The mean time to physician contact was 13.4 +/- 2.3 hours (median, 4.0 hours) and to neurologist contact was 21.2 +/- 2.9 hours. A skewed distribution of presentation times accounts for the mean-median differences. A small number of patients presenting very late could have an effect on the correlations between presentation time and the variables studied. Early presentation time was associated with increased age, the sudden onset of a stable deficit, and recognition that the symptoms signified stroke. Only the sudden onset of a stable deficit correlated independently with early presentation time (P = .0048). There was no correlation between presentation time and prior transient ischemic attack or stroke, headache, vomiting, loss of consciousness or seizures at onset, or stroke subtype, but a type II error could not be excluded.
Despite their education level, regular health care, and risk factors, especially prior stroke and transient ischemic attack, these patients were not knowledgeable about stroke and delayed many hours before contacting physicians. The course of symptoms and recognition that they signified stroke were associated with earlier presentation. Patient education focused on groups at risk may hasten the presentation and treatment of acute stroke.
出现中风症状的患者通常会延迟数小时才寻求医疗救治。我们试图探究与中风患者尽早就诊相关的因素。
我们对连续收治于三家大型城市医疗中心的100例急性中风患者进行了前瞻性研究。通过标准化的结构化访谈和病历审查，我们评估了患者对中风的了解情况、危险因素、中风的临床特征、中风识别来源以及就诊时间。我们未研究中风发病地点与医生接触地点之间的距离。
96例患者的中风发病时间已知。患者平均年龄为71.3岁，79%至少有一种中风危险因素，26%曾有短暂性脑缺血发作，19%曾有中风，74%接受过高中及以上教育，86%有固定的医生。只有8%曾接受过中风症状方面的教育。81%的中风为缺血性中风。与医生接触的平均时间为13.4±2.3小时（中位数为4.0小时），与神经科医生接触的平均时间为21.2±2.9小时。就诊时间的偏态分布导致了均值与中位数的差异。少数就诊非常晚的患者可能会影响就诊时间与所研究变量之间的相关性。尽早就诊与年龄增加、稳定性功能缺损的突然发作以及认识到症状意味着中风有关。只有稳定性功能缺损的突然发作与尽早就诊独立相关（P = 0.0048）。就诊时间与既往短暂性脑缺血发作或中风、头痛、呕吐、发病时意识丧失或癫痫发作或中风亚型之间无相关性，但不能排除II类错误。
尽管这些患者有一定教育水平、接受常规医疗保健且存在危险因素，尤其是既往中风和短暂性脑缺血发作，但他们对中风并不了解，在联系医生之前延迟了数小时。症状过程以及认识到症状意味着中风与更早就诊有关。针对高危人群的患者教育可能会加快急性中风的就诊和治疗。
