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Patient behaviour at the time of stroke onset: a cross-sectional survey of patient response to stroke symptoms
  1. L Mellon1,2,
  2. F Doyle1,
  3. D Williams2,
  4. L Brewer2,
  5. P Hall2,
  6. A Hickey1
  1. 1Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
  2. 2Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
  1. Correspondence to Dr Lisa Mellon, Division of Population Health Sciences, Department of Psychology, Royal College of Surgeons in Ireland, Dublin 2, Ireland; lisamellon{at}


Background and purpose Revascularisation treatment with thrombolysis must be initiated within 4.5 h following ischaemic stroke symptom onset. Despite its proven benefits, thrombolysis therapy is underused, with patient delay in presenting to hospital with symptoms identified as the leading barrier. This study aimed to examine help-seeking behaviour at stroke onset, in order to understand delays in accessing acute medical care for stroke symptoms.

Methods 149 consecutive patients hospitalised with ischaemic stroke were interviewed at 72 h poststroke with the Stroke Awareness Questionnaire and the Response to Symptoms Questionnaire.

Results Sixty per cent of stroke cases presented to the ED within 3.5 h of stroke onset. Knowledge of stroke symptoms and risk factors was poor, with 40% unable to correctly define a stroke. Bystander recognition of symptoms (p=0.03) and bystander initiation of Emergency Medical Services was associated with ED presentation within 3.5 h (p=0.03).

Conclusions This study provides insights into patient response when a stroke occurs, with the presence and action of others highlighted as critical in fast response to stroke symptoms. Knowledge of stroke warning signs and risk factors was low among stroke survivors. Findings highlight the complexity of changing help-seeking behaviour during stroke onset, and provide directions for public education efforts to reduce prehospital delay.

  • education
  • neurology, stroke
  • pre-hospital
  • stroke
  • thrombolysis

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