Stroke treatment still very often delayed

NEW YORK (Reuters Health) - Stroke victims frequently fail to seek emergency treatment promptly enough, and even when they do get to the ER quickly, their treatment is often delayed, a new study shows.

"Our study shows that most people with stroke symptoms still do not get to the hospital in a timely manner," lead researcher Dr. Kathryn R. Rose, of the University of North Carolina, Chapel Hill, told Reuters Health.

"This precludes them from being considered for time-dependent treatments that can reduce disability and death following a stroke."

In most cases, strokes are caused by a blood clot hindering blood flow to the brain. A drug called tissue plasminogen activator, or tPA, can be used to dissolve the clot and limit stroke damage, but it must be given within three hours of a person's first symptoms.

In their study, Rose and her colleagues found that of 15,177 patients in a North Carolina stroke registry, less than one-quarter arrived at the hospital within two hours of symptom onset. Of these patients, just 24 percent received a CT scan within the recommended time frame.

The researchers report the findings in the journal Stroke.

A CT scan is considered crucial to stroke diagnosis, and one must be done before tPA can be given. National guidelines call for running a CT scan within 25 minutes of a patient's arrival at the hospital, regardless of when their symptoms began.

Yet, Rose and her colleagues found, among stroke patients who arrived at the hospital more than two hours after their symptoms started, only 9 percent received a CT scan within 25 minutes.

"While patients that arrive to the hospital within 2 hours of symptom onset are more likely to receive a timely CT scan than those who do not," Rose said, "most do not. This points to areas where stroke systems of care within hospitals can be improved."

One way stroke sufferers might improve their odds of prompt treatment is to call an ambulance, the study suggests.

Patients who arrived via emergency medical services were twice as likely to receive a timely scan as those who arrived on their own, the researchers found.

Given the implications of timely arrival, Rose said, "it is important for people to recognize the symptoms of stroke and promptly call emergency services when they occur."

SOURCE: Stroke, online August 7, 2008.