Interpretation of symptoms and delay in seeking treatment by patients who have had a stroke: exploratory study

The purpose of this exploratory study was to examine the knowledge of stroke symptoms and risk factors in patients who have had a stroke and examine factors contributing to longer patient delay times during stroke.

Patients who had experienced an ischemic stroke and were able to understand and respond to questions were eligible to participate. A structured interview was used to identify patients' knowledge about symptoms and causes of stroke and the sequence of events from recognizing symptoms to accessing the emergency department (ED).

Twenty-six women and 12 men participated. Patients' ages ranged from 33 to 84 years (M = 62), and 44.7% were African-American, 39.5% were non-Hispanic white, and 15.8% were Latino. Only 60.5% of patients accurately identified one risk factor for stroke, and 55.3% were able to accurately identify at least one symptom of stroke. Patients' median delay time from the onset of symptoms to admission for stroke in the ED was 16 hours; only 12 patients (31.6%) accessed the ED in less than 2 hours. The most frequently reported symptom was weakness, which was experienced by 60% of the sample. The variables that were significantly related to longer delay time were as follows: African-American or Latino; lack of recognition of the seriousness of the symptoms; primary symptom was not motor; did not use 911; and resided in an urban setting. Logistic regression analysis showed that nonmotor symptoms as the primary symptom and not using 911 were significant predictors of delay longer than 2 hours. Someone other than the patient made the decision to seek treatment in 66% of the situations.

Educational interventions should be targeted to high-risk groups and their family members and should include not only stroke symptoms but also an action plan (call 911) when stroke symptoms are experienced.