Factors related to decision delay in acute stroke

Abstract

Background: The time from symptom onset to seeking medical assistance (decision delay) accounts for a proportion of prehospital delay in acute stroke. The aims of this study were to identify factors related to decision delay and calling the emergency medical services (EMS) as the first medical contact.

Methods: Data were prospectively collected from 350 patients with acute stroke or transient ischemic attack. Data on decision delay, prehospital delay, types of first medical contact, and previous stroke knowledge were recorded. Multivariable logistic regression analyses were conducted to identify factors related to decision delay of 1 hour or less and calling the EMS as the first medical contact.

Results: The median decision delay was 2.0 hours. Decision delay accounted for 62.3% of prehospital delay (median value). Moderate (National Institutes of Health Stroke Scale [NIHSS] score 8-16; odds ratio [OR] 4.16 [95% confidence interval 1.86-9.30]) or severe symptoms (NIHSS score ≥ 17; OR 10.38 [2.70-39.90]) and living together (OR 1.84 [1.02-3.43]) were associated with decision delay of 1 hour or less. Moderate (OR 6.31 [2.79-14.29]) or severe symptoms (OR 8.44 [2.64-26.98]) were associated with calling the EMS as the first medical contact. Previous stroke knowledge did not affect an early decision or EMS use.

Conclusions: The decision to seek medical assistance in acute stroke accounts for more than half of the prehospital delay. Severity of symptoms and living together are related to an early decision (≤1 hour). Previous stroke knowledge does not affect decision delay or EMS use.

Keywords: Prehospital delay; behavior; decision; stroke; stroke knowledge; thrombolysis.