Stroke patients' interpretation of symptoms and presentation to hospital

Abstract

The aim of this study was to elucidate patient interpretation of stroke symptoms and to investigate factors which influence timely presentation to hospital. Methods: All patients admitted to Mater Dei Hospital with a diagnosis of cerebrovascular accident (CVA) or transient ischaemic attack (TIA) between July and September 2011 were recruited prospectively. Data was collected by patient interview and with reference to medical notes in order to determine patient risk factors for stroke, knowledge on stroke, interpretation of stroke symptoms and time interval to presentation to hospital. Results: The cohort studied (N=54) had an average age of 67.9 years (SD=10.407). The risk factors for cerebrovascular disease most frequently found in this group were hypertension (56\%), hypercholesterolaemia (56%), family history of stroke (41%) and smoking (39%). Participants interpreted their symptoms as stroke in 33% of cases (n=18), whereas 48% reported that they did not know or suspect any particular cause at the time. The perceived severity of events at symptom onset was reported as ‘high’ by 41% and ‘low’ by 57%. Only 31\% of participants (n=17) recognised the brain as the organ primarily affected in stroke. Forty five percent of patients sought medical advice within one hour. Fifty-six percent (n=30) first resorted to their family doctor, whilst 28% (n=15) phoned the emergency services. Family doctor as first contact was associated with delayed presentation (p = 0.007); conversely, phoning emergency services was associated with earlier presentation to A\&E. Conclusion: The results of this study highlight limited knowledge about stroke in the population involved. It also serves to clarify factors contributing to high rates of late presentation. These findings show the need for an improvement in public awareness in terms of education on stroke and the importance of early presentation to hospital.