Delays

Department of Public Health Sciences

Home of the
South LondonIStroke Register SLSR

Investigating the reasons for delay in hospital admission and treatment after stroke

Funded by:

South Thames R&D 1999-2000

Study team:

Ms Sue Clegg

Dr Pandora Pound

Dr Anthony Rudd

Prof Charles Wolfe*

Background:

It is well documented that delays often occur between patients' initial experience of stroke symptoms and medical help being sought. New therapies for stroke need to be administered to patients within a narrow time window. Other studies have documented the length of delays and the points at which they occur, but little work has been done on exactly why delays happen.

Setting:

Inner city London

Aims:

1. to investigate delay times and points of delay from symptom recognition through to hospital arrival, diagnosis, CT/MRI scanning and treatment with aspirin

2. to understanding the reasons why patients often delay seeking medical assistance

Design:

1. Quantitative survey of all patients entered onto the South London Stroke Register (SLSR)

2. Qualitative interviews with stroke patients about events in the early stages of stroke

Results:

The prospective sample comprised patients entered onto the SLSR and hospitalised in St. Thomas' Hospital. Semi-structured interviews were carried out with 20 patients and/or witnesses to the acute stages of stroke. Analysis focussed on the meanings patients and witnesses attributed to symptoms.

Three key findings arose from the qualitative part of the study:

Patients for whom first symptom of stroke was collapse did not undertake a decision process

Patients who did not collapse attempted to rationalise their symptoms and to understand them in terms of previous knowledge and experience; and

Delays occurred whilst the rationalisation process was undertaken: medical help was sought when symptoms persisted for long periods (up to 60 hours, mean 17.7 hours), or worsened, or when friends/family persuaded patients that their symptoms required medical attention

Conclusion:

Literature on symptom recognition, intended for people at risk of stroke, often emphasises 'sudden onset' of symptoms. However, for many people in this study such terminology would be confusing. In lay terms onset was understood to be slow, demonstrated by patients' rationalisation of their situations. Future health campaigns designed to encourage early medical intervention for stroke need to take account of lay meanings and understanding of symptoms. Further analysis will be undertaken.