Patients who experience a sudden ischemic stroke can benefit from administration of intravenous tissue plasminogen activator (tPA) to reduce the resulting disability, yet few arrive in time to be eligible for tPA administration. The purpose of this study was to determine (a) the stroke warning signs that most commonly result in the decision to seek hospital care, (b) who makes the decision to seek hospital care, (c) the most common mode of transportation to the hospital, (d) hospital arrival time in relation to the onset of the first warning sign, and (e) factors most associated with hospital arrival time for stroke survivors. Using a descriptive, cross-sectional design, data from a convenience sample of 50 stroke survivors and/or their companions (family, friends, or others seeking hospital care for the patient) were obtained by face-to-face interview during the patient's hospital stay using a structured interview guide developed by the investigator. The most common stroke warning sign resulting in the decision to seek medical care was sudden confusion and trouble speaking or understanding speech, followed by sudden numbness or weakness on one side of the body. Patients themselves were the most common initiators of care, followed by spouses, other relatives, and others. A majority of patients arrived by ambulance, followed by private car or taxi. Only 28.9% of patients arrived at the hospital within 3 hours of the first warning sign, with the mean arrival time for the group being 330.4 minutes (5.5 hours). Mode of transportation and perceived adequacy of income were the only significant factors associated with hospital arrival time, with no significant interaction effects. Patients arriving by private car or taxi and those perceiving their incomes as comfortable had the longest arrival times, suggesting public education efforts also should target people from higher socioeconomic groups. The nonsignificant associations between hospital arrival time, warning signs, and other demographic characteristics of initiators suggest there may be other unmeasured behavioral factors that play a more important role in reducing hospital arrival time for stroke patients. Further study of additional factors associated with early hospital arrival time is recommended to support educational efforts for early stroke treatment and prevention.
Questions or comments about this article may be directed to: Tamilyn Bakas, DNS RN FAHA, by phone at 317/274-4695 or by e-mail at firstname.lastname@example.org. She is an associate professor at the Indiana University School of Nursing, Indianapolis, IN.
Lenora M. Maze, MSN RN CNRN CNS, is a clinical nurse specialist at Critical Care and Neuroscience Wishard Health Services, Indianapolis, IN.
© 2004 American Association of Neuroscience Nurses