Delay in seeking treatment by patients with stroke: Who decides, where they go, and how long it takes

Objectives: To find out about stroke patients: who decides to seek medical help, where they go, how long it takes to contact the health system and to arrive at the ED. Methods: Prospective study of patients admitted in our hospital for transient or established stroke. Results: Among 388 stroke patients (mean NIHSS of 7.8 (+/- 7.4), there were 37 intracerebral hemorrhage, 70 TIA, and 281 cerebral infarction. 39.2% arrived at the ED in less than 3 h. The decision to seek medical help was taken by patients in 20.4% of the episodes. First contact was with primary care in 48.3% of the cases and with Emergency Medical Services in 18.2%. The median time of decision was 60 min [P25:15; P75:323]. Considering the event as serious, recognizing the stroke, not going to a primary care physician, having a TIA and onset away from home significantly decreased delay. Age, sex and previous stroke were not associated with less delay in decision nor with an earlier arrival to the ED. Conclusions: In order to improve stroke treatment it is necessary to harness the use of the 112 emergency line and include primary care in the stroke assistance chain. (C) 2011 Elsevier B.V. All rights reserved.