Original ArticlePoor Recognition of Prompted Treatment Seeking Even with Good Knowledge of Stroke Warning Signs Contribute to Delayed Arrival of Acute Ischemic Stroke Patients in Thailand

Intravenous recombinant tissue plasminogen activator given within 4.5 hours after the onset of ischemic stroke is the most powerful standard treatment for patients with acute ischemic stroke. However, most of the patients arrive at the hospital later than 4.5-hours time window for intravenous thrombolysis. We study the factors that might contribute to delayed arrival in patients with acute ischemic stroke. One hundred eighty-one acute ischemic stroke patients (or their respondents) who admitted in stroke unit of 3 different hospitals were interviewed with a questionnaire regarding knowledge of stroke warning signs and recognition of prompted treatment seeking (Stroke Act FAST). Eighty-nine patients who arrived during 4.5 hours after onset were categorized as on-time group and the rest fell into delayed group. Initial National Institutes of Health Stroke Scale, nature of onset (sudden or gradual/fluctuation), day interval of the onset (8 am to 4 pm, 4 pm to midnight, or midnight to 8 am), mode of transportation, place of onset, knowledge of stroke warning signs, and prompted treatment seeking (Stroke Act FAST) were compared between 2 groups. Patients in on-time group presented with sudden-onset nature much more than patients in delayed group (P = .006). Association factors including day interval of the onset, mode of transportation, place of onset and knowledge of stroke warning signs are not different between groups (P > .05), whereas recognition of prompted treatment seeking is better in on-time group than in delayed group. In conclusion, good knowledge of stroke warning signs, most severe stroke, onset at workplace, onset during daytime, and ambulance for transportation are not associated with early arrival within 4.5-hours time window. However, sudden-onset nature and prompted treatment seeking may predict early arrival.