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26-04-2010 | Stroke | Article

Minor stroke patients slow to seek help

Abstract

Free abstract

MedWire News: Most patients having a minor stroke or transient ischemic attack (TIA) do not realize what is happening to them, show findings from the Oxford Vascular Study.

“Without more effective public education, the full potential of acute prevention will not be realized,” say Peter Rothwell (Radcliffe Infirmary, Oxford, UK) and colleagues in the journal Stroke.

They add: “To date, most campaigns have focused on symptom recognition, but we found that even when patients correctly recognized the event, they often did not seek attention urgently, suggesting that public education should focus more strongly on the need to seek medical attention as soon as possible.”

The researchers interviewed 1000 patients with TIA (n=459) or minor stroke (n=541). They found that 68% of TIA patients and 69% of stroke patients did not know what had caused their symptoms, or assumed a different, incorrect cause.

About half of the patients – 47% and 46% of those with TIA and minor stroke, respectively – sought medical help within 3 hours of symptom onset, the therapeutic window for thrombolysis. And 67% and 74%, respectively, sought help within 24 hours.

TIA patients with motor or speech symptoms, or with symptoms lasting longer than 1 hour presented after about 2 hours, compared with 11.5–25.0 hours for other patients. Patients also presented earlier if they had previous stroke and if they had an ABCD2 score of 5 or more.

TIA patients who recognized their symptoms presented earlier than those who did not, at 2.3 versus 7.2 hours, but this became nonsignificant after accounting for clinical characteristics such as speech and motor symptoms.

Factors including age, gender, educational level, and social class did not influence speed of presentation among TIA patients, and no factor significantly affected the speed of presentation of stroke patients.

Forty-one patients had suffered a previous TIA or stroke for which they had not sought medical attention. Compared with the cohort as a whole, the first event in these patients was more likely to have been a TIA than a stroke, with a shorter duration of symptoms, and no motor or speech symptoms. These patients comprised 31% of those with recurrent events, meaning that a nearly third of recurrent events occurred before the patient had received medical attention.

“More encouraging was the observation that patients at higher predicted stroke risk were more likely to act like in an emergency, apparently due to the influence of weakness and prolonged symptom duration on behavior,” say Rothwell et al.

But they note that about a fifth of patients with ABCD2 scores lower than 4 have “pathology that might require urgent treatment, highlighting the importance of public education campaigns focusing on seeking urgent medical attention rather than purely symptom recognition.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Eleanor McDermid