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22-07-2009 | Stroke | Article

Patients responsible for delay in assessment after TIA


Free abstract

MedWire News: The majority of delay in seeking assessment after transient ischemic attack (TIA) is due to a lack of response by the patient, UK research shows.

“Many patients do not recognize the symptoms of stroke or TIA, and even when they do, many fail to seek emergency medical attention,” observe Nikola Sprigg and colleagues from the University of Leicester.

To examine potential factors associated with delay in seeking medical assessment after TIA, Sprigg and team carried out a systematic review of observational studies published between December 1995 and September 2008.

The researchers identified nine studies with data on presentation delay in patients with TIA. They report that variations existed in study size, population, and methodology, meaning pooling of results or meta-analysis were not possible.

One study included patients with TIA only (n=241), whereas the remaining eight studies recruited both stroke and TIA patients. Overall, TIA patients (n=821) made up only 26% of the total number of patients (n=3202) studied.

Length of delay varied greatly across all studies. Less of a delay was consistently seen in patients (stroke and TIA) who used emergency medical services (EMS) rather than visiting their general practitioner (GP), although patients with TIA were less likely than stroke patients to use EMS. In most studies, patients with TIA who attended EMS arrived there within hours.

Where patients first presented to their GP, 50% attended within 24 hours whereas 25% waited 2 days or more. In one study, half of all patients with TIA failed to recognize their symptoms. Even so, recognition of symptoms as stroke or TIA did not reduce the delay or increase the proportion of patients who sought EMS.

Of note, the presence of a witness at symptom onset reduced delay across stroke and TIA patients, but no data was available on the influence of a witness in patients with TIA alone.

“Although the development of 24-hour TIA assessment services is important, more work is needed to educate the public to seek medical review immediately after TIA in an attempt to avoid recurrent stroke and its devastating consequences,” conclude Sprigg and co-authors in the Journal of Neurology, Neurosurgery, and Psychiatry.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

By Laura Dean