Interpretation of symptoms and delay in seeking treatment by patients who have had a stroke: exploratory study

Abstract

Objectives: The purpose of this exploratory study was to examine the knowledge of stroke symptoms and risk factors in patients who have had a stroke and examine factors contributing to longer patient delay times during stroke.

Methods: Patients who had experienced an ischemic stroke and were able to understand and respond to questions were eligible to participate. A structured interview was used to identify patients' knowledge about symptoms and causes of stroke and the sequence of events from recognizing symptoms to accessing the emergency department (ED).

Results: Twenty-six women and 12 men participated. Patients' ages ranged from 33 to 84 years (M = 62), and 44.7% were African-American, 39.5% were non-Hispanic white, and 15.8% were Latino. Only 60.5% of patients accurately identified one risk factor for stroke, and 55.3% were able to accurately identify at least one symptom of stroke. Patients' median delay time from the onset of symptoms to admission for stroke in the ED was 16 hours; only 12 patients (31.6%) accessed the ED in less than 2 hours. The most frequently reported symptom was weakness, which was experienced by 60% of the sample. The variables that were significantly related to longer delay time were as follows: African-American or Latino; lack of recognition of the seriousness of the symptoms; primary symptom was not motor; did not use 911; and resided in an urban setting. Logistic regression analysis showed that nonmotor symptoms as the primary symptom and not using 911 were significant predictors of delay longer than 2 hours. Someone other than the patient made the decision to seek treatment in 66% of the situations.

Conclusion: Educational interventions should be targeted to high-risk groups and their family members and should include not only stroke symptoms but also an action plan (call 911) when stroke symptoms are experienced.