09 March 2009

Many miss out on stroke treatment

Most people who have strokes don't act quickly enough to get the clot-dissolving treatment that can limit brain damage, a new study finds.


Most people who have strokes don't act quickly enough to get the clot-dissolving treatment that can limit brain damage, a new study finds.

"One of the problems is that a lot of people don't realise that they are having a stroke," said Kathryn M. Rose, a research associate professor of epidemiology at the University of North Carolina, and author of a report in an issue of Stroke.

Hospital personnel can share some of the blame for tardy treatment, Rose added. "There is also delay time among people who get to the hospital quickly, so there is room for the medical community to act," she said.

Rose and her colleagues studied data on 15 117 people treated for strokes at 46 hospitals in North Carolina between 2005 and 2008. Treatment for an ischaemic stroke, in which a clot blocks a blood vessel in the brain, is an injection of clot-dissolving tissue plasminogen activator (tPA), but that is effective only in the first three hours after a stroke occurs.

In practice, that means arriving at a treatment centre within two hours, Rose said, because "once you get there, you need to be diagnosed. There's a very narrow window in which you can get treatment."

Diagnosis made too late
Only 23 percent of the people in the study arrived at hospitals within two hours of the onset of symptoms. The recommendation is that someone suspected of having a stroke should have a computerised tomography scan within 35 minutes to confirm the diagnosis. Of the 3 549 people who arrived within two hours of having symptoms, only 23.6 percent had a CT scan in the recommended times.

"We found that women were less likely to get timely treatment," Rose said. "Also, treatment was faster in hospitals that were certified stroke centres, which have a formal plan for diagnosis and treatment."

Another important influence was the way people got to a hospital. "They were treated more quickly when they arrived by ambulance," Rose said. "It is better to call the EMS than to take yourself to the hospital."

People brought in by ambulance by the emergency medical service were twice as likely to get a timely CT scan, the study found. And while gender made a difference, race, health insurance status, time of day or weekend arrival did not.

Recognise symptoms early
"The whole thing is recognising a stroke on both ends: the person who is having it, getting to the hospital in timely fashion, and also when they arrive at the hospital," said Dr Claudette Brooks, an assistant professor of neurology at West Virginia University, and a spokeswoman for the American Stroke Association.

Brooks said she instructs people who believe they are having a stroke to get to the emergency room immediately. If they insist on driving to the hospital, they should call ahead "so that when they walk in, they are not given a number by someone and put in a corner for several hours".

She advises against driving because "if something happens, and it is a very severe stroke, and someone suddenly stops breathing, what are you going to do, stop the car and give CPR?".

While diagnosis and treatment might be quicker at a hospital with a stroke centre "the important thing is to get to any hospital right away," Brooks said.,/p>

Warning signs
The American Stroke Association teaches the public to watch for these warning signs:

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.
  • Sudden confusion, trouble speaking or understanding.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking, dizziness, loss of balance or coordination.
  • Sudden, severe headache with no know cause.

- (Ed Edelson/HealthDay News)

Read more:
Stroke Centre

August 2008


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