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Open Access Research article

Stroke awareness decreases prehospital delay after acute ischemic stroke in korea

Young Seo Kim1, Sang-Soon Park2, Hee-Joon Bae3, A-Hyun Cho4, Yong-Jin Cho5, Moon-Ku Han3, Ji Hoe Heo6, Kyusik Kang7, Dong-Eog Kim8, Hahn Young Kim9, Gyeong-Moon Kim10, Sun Uk Kwon11, Hyung-Min Kwon12, Byung-Chul Lee13, Kyung Bok Lee14, Seung-Hoon Lee2, Su-Ho Lee15, Yong-Seok Lee12, Hyo Suk Nam6, Mi-Sun Oh13, Jong-Moo Park7, Joung-Ho Rha16, Kyung-Ho Yu13 and Byung-Woo Yoon2*

Author Affiliations

1 Department of Neurology, Hanyang University Hospital, Seoul, Republic of Korea

2 Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea

3 Department of Neurology, Seoul National University Bundang hospital, Seongnam, Republic of Korea

4 Department of Neurology, St. Mary's hospital, Seoul Korea

5 Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea

6 Department of Neurology, Yonsei University Severance Hospital, Seoul, Republic of Korea

7 Department of Neurology, Eulji General Hospital, Seoul, Republic of Korea

8 Department of Neurology, Dongguk University International Hospital, Koyang, Republic of Korea

9 Department of Neurology, Konkuk University Hospital, Seoul, Republic of Korea

10 Department of Neurology, Samsung medical center, Seoul, Republic of Korea

11 Department of Neurology, Asan medical center, University of Ulsan, Seoul, Republic of Korea

12 Department of Neurology, Seoul National University Boramae hospital, Seoul, Republic of Korea

13 Department of Neurology, Hallym University Sacred Hospital, Anyang, Republic of Korea

14 Department of Neurology, Soonchunhyang University Hospital, Seoul, Republic of Korea

15 Department of Neurology, Seoul-Daehyo Hospital, Seoul, Republic of Korea

16 Department of Neurology, Inha University Hospital, Incheon, Republic of Korea

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BMC Neurology 2011, 11:2  doi:10.1186/1471-2377-11-2

Published: 6 January 2011

Abstract

Background

Delayed arrival at hospital is one of the major obstacles in enhancing the rate of thrombolysis therapy in patients with acute ischemic stroke. Our study aimed to investigate factors associated with prehospital delay after acute ischemic stroke in Korea.

Methods

A prospective, multicenter study was conducted at 14 tertiary hospitals in Korea from March 2009 to July 2009. We interviewed 500 consecutive patients with acute ischemic stroke who arrived within 48 hours. Univariate and multivariate analyses were performed to evaluate factors influencing prehospital delay.

Results

Among the 500 patients (median 67 years, 62% men), the median time interval from symptom onset to arrival was 474 minutes (interquartile range, 170-1313). Early arrival within 3 hours of symptom onset was significantly associated with the following factors: high National Institutes of Health Stroke Scale (NIHSS) score, previous stroke, atrial fibrillation, use of ambulance, knowledge about thrombolysis and awareness of the patient/bystander that the initial symptom was a stroke. Multivariable logistic regression analysis indicated that awareness of the patient/bystander that the initial symptom was a stroke (OR 4.438, 95% CI 2.669-7.381), knowledge about thrombolysis (OR 2.002, 95% CI 1.104-3.633) and use of ambulance (OR 1.961, 95% CI 1.176-3.270) were significantly associated with early arrival.

Conclusions

In Korea, stroke awareness not only on the part of patients, but also of bystanders, had a great impact on early arrival at hospital. To increase the rate of thrombolysis therapy and the incidence of favorable outcomes, extensive general public education including how to recognize stroke symptoms would be important.