Effects of public and professional education on reducing the delay in presentation and referral of stroke patients

Background and Purpose: Several emerging stroke therapies require patients to be treated within several hours of symptom onset. Past studies have documented a significant delay between symptom onset and hospital presentation. As part of an experimental treatment study using tissue-type plasminogen activator, we began a multifaceted program of public and professional education to reduce the delay in presentation and referral of acute stroke patients. Methods: The educational efforts focused on improving the recognition of stroke symptoms, the study enrollment criteria, and the need for rapid treatment of stroke patients. This program included 1) interviews on television and radio, 2) newspaper articles, 3) lectures to local and regional primary care and emergency department physicians, 4) mailings to several thousand local physicians, 5) having neurologists on-call for referrals 24 hrs/day, and 6) use of the Duke Life-Flight helicopter. Results: Since starting our program, 139 of 159 (86%) patients with cerebral infarction presented primarily to or were referred to our facility within 24 hours of symptom onset, compared with 70 of 187 (37%) before our educational efforts (p<0.00001). No significant change was seen in patients with intracerebral hemorrhage (23 of 30 [77%] within 24 hours after program, compared with 25 of 40 [63%] before educational efforts; p=0.30). Conclusions: These findings suggest that educational efforts aimed at the public and health professionals may increase recognition of stroke symptoms and reduce the delay in presentation and referral of stroke.