Patients and relatives behaviour during acute stroke and their association with clinical characteristics

Aim: One of the most important factors that obstacle the benefit from thrombolytic therapy is delayed arrival at hospital. In this study we aimed to determine the factors that affect early arrival to the hospital by investigating the clinical characteristics and behaviors of acute ischemic stroke patients and relatives and their association with early hospital admission.Materials and Methods: 115 patients with acute ischemic stroke have been included in this prospective study which was conducted between May 2011-January 2012 in Karadeniz Technichal University Medical Faculty. The demographic data of patients, prehospital delay times, clinical situation, emotional and behavioral reactions of the patients and their relatives and stroke knowledge have been assessed. Univariate and multivariate analyzes were performed to determine the factors affecting early admission to the hospital.Results: The mean age of 115 patients was 68.7±13.5 (27-90), 47 were women (40.9 %), 68 were men (59.1 %). The median time from the beginning of stroke symptoms to arrival to the hospital was 70 minutes (15-4340). 82 patients (71.3 %) arrived to the hospital within 3 hours while the number of patients arrived to the third step health center where the thrombolytic therapy is available was 55 (47.8 %). The factors affecting the arrival to the hospital within three hours after the onset of stroke symptoms were advanced age, having atrial fibrillation and coronary artery disease, sudden onset of stroke, sensation of panic or fear at the time of stroke, impairment of consciousness or motor symptoms, high NIHSS score, short duration of the time to seeking help, call the 112, being treated in the first referenced hospital and the perception of initial sypmtoms by the patients or their relatives as stroke. On multivariate analysis, having atrial fibrillation (OR,4.03; 95% CI, 1.04-15.6) and high NIHSS score (OR,1.1;95% CI, 1.2-1.28), considering the initial symptoms as the stroke (OR,3.3; 95% CI, 1.2-9.3) were detected to be the independent factors that affecting early arrival to the hospital.Conclusions: The factors that influence early arrival of the acute ischemic stroke patients were not only the clinical characteristics of the patients, but also the recognition of stroke by patients or their relatives and emotional and behavioral responses were found to be important. Therefore there is a need for public awareness about symptoms of stroke and emergency medical assistance. Additionally, special call centers that may increase the chance of thrombolytic therapy for stroke patients and special stroke units in the centers that apply thrombolytic treatment will be beneficial to increase the number of patients that may benefit from thrombolytic therapy.