Stroke

Decisions, delays keep patients from timely stroke treatment

Time is critical when someone has a stroke, but care can be delayed when victims, bystanders or even health workers don’t recognize the emergency, a new study in the UK finds.

Better public awareness of the signs of stroke and the importance of seeking immediate emergency care are needed, the authors say.

Stroke signs include the sudden onset of various symptoms such as confusion, difficulty speaking, droopy face or slurred speech, weakness in a limb, numbness, being off-balance, visual loss or a really severe headache.

“Getting to hospital quickly is particularly important for patients who suffer certain types of stroke, because they can benefit from clot busting drugs, but only if these are given within hospital within 4.5 hours of symptoms starting,” Ruth Mellor, who led the study, told Reuters Health by email.

“We knew from earlier research that people who have a stroke can take a long time to get to hospital and wanted to understand why that was,” said Mellor, who is a researcher with the National Health Service Lanarkshire.

Her team interviewed 30 stroke patients to learn about their decisions and experiences, with an emphasis on the routes that eventually got them to the hospital for stroke treatment.

All the patients lived in cities. Most were white men, under age 65. Most strokes occurred at home.

Eighteen patients contacted a health service before going to the emergency department, but the remaining 12 took more circuitous routes to the hospital.

Less than half arrived at the emergency department within three hours of their first symptoms, but no times were recorded for 11 of the patients, the researchers reported in Annals of Emergency Medicine.

Delays in getting treatment happened when patients didn’t recognize the severity of their symptoms or decided to contact their primary care doctor instead of emergency services.

Bystanders were often important. Eleven patients reportedly sought help from friends or family to make sure something was definitely wrong, while 12 patients resisted the idea that they were having a stroke and were forced by bystanders to get help.

In eight cases, bystanders actually delayed the process, possibly because they didn’t want to take responsibility for the decisions, the study team writes.

The researchers also found delays in care when health care workers didn't recognize the severity of symptoms. Two patients were misdiagnozed at the hospital and sent home.

"People experiencing stroke symptoms may not always be the best judge of the seriousness of the symptoms, bystanders have a big role to play in recognition of stroke and helping people to get to appropriate care,” Mellor said.

Calling the emergency medical services number (911 in the U.S.) “so that an ambulance can take them to hospital quickly can make a real difference,” Mellor said.

“People need to think 'FAST': Face drooping, Arm weakness, and Speech difficulty, then Time to call 911,” Mellor said.

Dr. Justin Sattina, a neurologist at the University of Wisconsin School of Medicine and Public Health in Madison who was not involved in the UK research, said the importance of bystanders stood out for him.

“It's a story I’ve heard plenty of times, that the patient resisted seeking help but the spouse insisted or they call the daughter who happens to be a nurse or whatever, and that's why they’re here,” Sattin said.

He told Reuters Health he always reinforces that behavior. “The husband will be angry that the wife called 911 and it caused a big scene with the ambulance out in front at their house, and I say ‘no, no, no, your wife did the right thing,’” Sattin said. “I see these little looks of thanks when I reinforce that for the family.”

Sattin said calling 911 is better than calling a relative or a doctor because then the hospital gets alerted to be ready.

“The thing about coming in by 911 is that there's pre-notification to the hospital that there's a stroke patient coming in and everything clicks along faster,” Sattin said.

There’s no time wasted in the waiting room, he said, and some hospitals bypass the emergency room entirely and take patients straight to the CT scanner.

“You don’t get the benefit of that if you (drive to the hospital), even if it's true that you arrive at the front door a little quicker, it disrupts what’s really an intricate and adjusted process of caring for acute stroke patients,” Sattin said.