For stroke treatment, even 15 minutes can make a difference in outcome

Time makes a big difference when it comes to outcomes for people who experience a stroke.

Even a few minutes can apparently make a difference.


In one of the largest studies of its kind, researchers at the University of California, Los Angeles David Geffen School of Medicine looked at more than 6,700 people who were treated in clinical practice.

Their study results were published in The Journal of the American Medical Association (JAMA).

The researchers reported that treatment administered just 15 minutes sooner resulted in 15 fewer deaths per every 1,000 patients.

In addition, the earlier treatment resulted in 17 people per 1,000 being able to walk out of the hospital under their own power and 22 people per 1,000 were able to care for themselves outside of the hospital.

The findings shine new light on the importance of recognizing and acting quickly on the early signs of a stroke.

Focusing on time

Researchers looked at two separate time points in the study.

The first was the time from the onset of stroke symptoms to treatment.

The second was from the time of arrival at the hospital to treatment.

“With regard to patients arriving in the hospital and the time to treatment after that, that’s entirely within the hospital’s control,” explained Dr. Reza Jahan, the co-lead author of the study and professor at the Ronald Reagan UCLA Medical Center.

“They have control of that, they have processes in place to expedite that, and so on and so forth,” Jahan told Healthline. “But onset to treatment, part of that is outside the control of the hospital.”

Once a person does arrive at the hospital, a number of factors can influence how quickly they’re seen by a doctor.

While arriving during an emergency room’s “off hours” might suggest a shorter waiting list and faster treatment, the opposite is true.

Researchers found that patients who arrived on a weekend, or between 6 p.m. and 7 a.m. on a weeknight, saw delayed treatment.

“It could be the fact that many hospitals don’t have enough personnel on-call for stroke treatment,” said Jahan. “Each hospital needs to look at their own data and look at their numbers. If hospitals are delayed on the off-hours, every hospital now has to do a root cause analysis to see what their issues are and why there’s delay to treatment.”


Another factor is a person getting transferred to another medical facility.

One treatment option for stroke is known as a thrombectomy procedure, where a blood clot is removed from a blood vessel.

If the hospital a person arrives at isn’t capable of performing a thrombectomy, the person will need to be transferred to a hospital that can.

“We’re trying to change the systems of care for stroke patients,” said Jahan. “So if a patient is recognized out in the field by the EMS to be having a severe stroke, they should be taken directly to a hospital that’s capable of the thrombectomy procedure.”

Recognizing the signs

While hospitals and health systems can work to reduce wait times for people having strokes, they can’t do anything for a person until they arrive at the hospital.

Unlike many medical issues, such as heart attacks, the symptoms of a stroke aren’t painful or acute.

“If you have some numbness or weakness in your arm, that doesn’t hurt. Heart attacks hurt,” explained Jahan.

One way to quickly remember the symptoms is the acronym FAST, which stands for face, arms, speech, and time to call 911.

Anyone who recognizes one of these symptoms in themselves, whether it’s a numb arm or a drooping face, should call 911 immediately.

But physical and even cognitive issues can make it difficult for a person to help themselves. In these cases, an onlooker could mean the difference between life and death.

“They can produce very severe neurological problems like paralysis, but because it affects the brain at the same time, that can impair the person’s ability to recognize that anything’s wrong,” said Dr. Richard Libman, vice chair of neurology at Long Island Jewish Medical Center in New Hyde Park, New York.

“A person can have complete paralysis and crash to the floor, but then if you ask the patient if anything’s wrong, they may say no,” Libman told Healthline.

Libman said that many people may want to call their family doctor in this situation, but it’s best to just call 911.

“The doctor might say, ‘Well, come to the office, I’ll check your blood pressure.’ But it doesn’t get the patient to the emergency department quickly, where they need to be in order to be treated,” Libman said.

Education is paramount

“We’ve made strides through constant efforts in public education and we’ve improved compared to, say, 20 years ago. But there are still major gaps in public education to recognize the signs and symptoms of a stroke,” said Libman.

“It’s not as if there has been no effort in this regard,” he added. “For 25 years, there have been many studies, many efforts to educate the public through lectures, going into nursing homes, assisted living facilities, places of worship, et cetera.”

Jahan cites the efforts made by the American Heart Association and the American Stroke Association to enact programs such as Get with the Guidelines as an example of public education initiatives.

“They emphasize this kind of quality improvement and, in fact, hospitals that had stroke certification had better door to treatment times,” he noted.


While hospitals and health networks can work to improve treatment time for stroke patients, they can only begin to help once the patient — or someone else — has taken the initiative to come to the hospital.

“One thing to emphasize is patient education, awareness of the signs and symptoms of stroke, and the importance of calling 911 if you see those symptoms,” said Jahan. “Don’t go to bed and think it’s going to go away, because you may wake up with a much larger stroke if you go to bed with symptoms. That is one thing that is out of our control that is entirely dependent on patient education.”

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