Neurological Sciences

, Volume 34, Issue 4, pp 449–455 | Cite as

What is still missing in acute-phase treatment of stroke: a prospective observational study

  • Sara Mazzucco
  • Giulia Turri
  • Rina Mirandola
  • Paolo Bovi
  • Giulia Bisoffi
  • Verona Hospital Stroke Study Group
Original Article


Early recognition of stroke symptoms and activation of emergency medical service (EMS) positively affects prognosis after a stroke. To assess stroke awareness among stroke patients and medical personnel in the catchment area of Verona Hospital and how it affects stroke care, we prospectively studied timing of acute stroke care in relation to patients’ characteristics. Patients admitted to Medical Departments of Verona University Hospital between January 1st and December 31st 2009 with a diagnosis of TIA or stroke were enrolled. Outcome measures were: time between (i) symptoms onset and hospital arrival, (ii) hospital arrival and brain CT scan, blood examination, ECG and neurological evaluation. The following patient/event characteristics were also collected: means of hospital arrival, sex, age, degree of disability, type of event (first or recurrent) and acute-phase treatment. Of 578 patients providing complete information, 60 % arrived to the emergency department with the EMS (EMS+ group), while 40 % arrived on their own (EMS−). EMS+ group was older than EMS− (mean age 76.2, SD 13.2, vs. 72.3, SD 13, respectively), displayed more severe symptoms (mRS 4 vs. 2) and shorter time interval between symptoms onset and hospital arrival, hospital arrival and CT scan, ECG, laboratory tests and neurological evaluation (p < 0.0001); 22 % of the EMS+ patients were stroke recurrences versus 29 % of the EMS− (p = 0.058); 85 % of thrombolised patients were EMS+. We conclude that there is a lack of awareness of stroke symptoms and risks of recurrence even among patients who already had a stroke and among medical personnel.


Stroke Stroke awareness Thrombolysis Emergency medical service Educational programs 


  1. 1.
    Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack (2008) The European Stroke Organization (ESO) Executive Committee and the ESO Writing Committee. Cerebrovasc Dis 25:457–507CrossRefGoogle Scholar
  2. 2.
    Qureshi AI, Kirmani JF, Sayed MA, Safdar A, Ahmed S, Ferguson R, Hershey LA, Qazi KJ, the Buffalo Metropolitan Area and Erie County Stroke Study Group (2005) Time to hospital arrival, use of thrombolytics, and in-hospital outcomes in ischemic stroke. Neurology 64:2115–2120PubMedCrossRefGoogle Scholar
  3. 3.
    Glader EL, Stegmayr B, Johansson L, Hulter-Asberg K, Wester PO (2001) Differences in long-term outcome between patients treated in stroke units and in general wards: a 2-year follow up of stroke patients in Sweden. Stroke 32:2124–2130PubMedCrossRefGoogle Scholar
  4. 4.
    Indredavik B, Bakke F, Slordal SA, Rokseth R, Haheim LL (1999) Stroke unit treatment. 10-year follow-up. Stroke 30:1524–1527PubMedCrossRefGoogle Scholar
  5. 5.
    Indredavik B, Bakke F, Slordahl SA, Rokseth R, Haeim LL (1999) Treatment in a combined acute and rehabilitation stroke unit. Stroke 30:917–923PubMedCrossRefGoogle Scholar
  6. 6.
    Morgenstern LB, Bartholomew LK, Grotta JC, Staub L, King M, Chan W (2003) Sustained benefit of a community and professional intervention to increase acute stroke therapy. Arch Intern Med 163:2198–2202PubMedCrossRefGoogle Scholar
  7. 7.
    Morgenstern LB, Staub L, Chan W, Wein TH, Bartholomew LK, King M, Felberg RA, Burgin WS, Groff J, Hickenbottom SL, Saldin K, Demchuk AM, Kalra A, Dhingra A, Grotta JC (2002) Improving delivery of acute stroke therapy: the TLL temple foundation stroke project. Stroke 33:160–166PubMedCrossRefGoogle Scholar
  8. 8.
    American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups (2007) Guidelines for the early management of adults with ischemic stroke. A guideline from the American heart association. Stroke 38:1655–1711CrossRefGoogle Scholar
  9. 9.
    World Health Organization (1987) The ninth revision of the international classification of diseases and related health problems (ICD-9), World Health Organization, Geneva. Accessed 7 Aug 2011
  10. 10.
    Kothari RU, Pancioli A, Liu T, Brott T, Broderick J (1999) Cincinnati Prehospital Stroke Scale: reproducibility and validity. Ann Emerg Med 33:373–378PubMedCrossRefGoogle Scholar
  11. 11.
    Hatano S (1976) Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ 54:541–553PubMedGoogle Scholar
  12. 12.
    Bamford J, Sandercock P, Dennis M, Warlow C, Jones L, McPherson K, Vessey M, Fowler G, Molynex A, Hughes T, Burn J, Wade D (1988) A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project 1981–86. 1. Methodology, demography and incident cases of first-ever stroke. J Neurol Neurosurg Psy 51:1373–1380CrossRefGoogle Scholar
  13. 13.
    Coutts SB, Hill MD, Campos CR, Choi YB, Subramaniam S, Kosior JC, Demchuk AM, the VISION study group (2008) Recurrent events in transient ischemic attack and minor stroke: What events are happening and to which patients? Stroke 39:2461–2466PubMedCrossRefGoogle Scholar
  14. 14.
    Williams L, Bruno A, Rouch D, Marriot D (1997) Stroke patients’ knowledge of stroke: influence on time to presentation. Stroke 28:912–915PubMedCrossRefGoogle Scholar
  15. 15.
    Kothari R, Sauerbeck L, Jauch E, Broderik J, Brott T, Khoury J, Liu T (1997) Patients’ awareness of stroke signs, symptoms and risk factors. Stroke 28:1871–1875PubMedCrossRefGoogle Scholar
  16. 16.
    Wester P, Radberg J, Lundgren B, Peltonen M (1999) Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA. Stroke 30:40–48PubMedCrossRefGoogle Scholar
  17. 17.
    Smith EE, Abdullah AR, Petkovska I, Rosenthal E, Koroshetz WJ, Schwamm LH (2005) Poor outcomes in patients who do not receive intravenous tissue plasminogen activator because of mild or improving ischemic stroke. Stroke 36:2497–2499PubMedCrossRefGoogle Scholar
  18. 18.
    Kruetzelmann A, Siemonsen S, Gerloff C, Rosenkranz M, Röther J, Fiehler J, Thomalla G (2009) Thrombolysis targeting MRI defined tissue at risk in minor stroke. J Neurol Neurosurg Psy 80:1156–1158CrossRefGoogle Scholar
  19. 19.
    National Stroke Association (1996) Stroke remains a deadly mystery to many Americans. Be Stroke Smart 13:2Google Scholar
  20. 20.
    Rudd AG, Hoffman A, Grant R, Campbell JT, Lowe D, on behalf of the Intercollegiate Working Party for Stroke Stroke thrombolysis in England, Wales and Northern Ireland et al (2011) How much do we do and how much do we need? J Neurol Neurosurg Psy 82:527–533CrossRefGoogle Scholar
  21. 21.
    Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, On behalf of the American Heart Association. Statistics Committee and Stroke Statistics Subcommittee et al (2010) Heart disease and stroke statistics—2010 update. A report from the American heart association. Circulation 121:e46–e215PubMedCrossRefGoogle Scholar
  22. 22.
    Meairs S, Wahlgren N, Dirnagl U, Lindvall O, Rothwell P, Baron JC et al (2006) Stroke research priorities for the next decade—A representative view of the European scientific community. Cerebrovasc Dis 22:75–82PubMedCrossRefGoogle Scholar
  23. 23.
    Chandratheva A, Lasserson DS, Geraghty OC, Rothwell PM, Oxford Vascular Study (2010) Population-based study of behavior immediately after transient ischemic attack and minor stroke in 1000 consecutive patients: lessons for public education. Stroke 41:1108–1114PubMedCrossRefGoogle Scholar
  24. 24.
    Summers D, Leonard A, Wentworth D, Saver JL, Simpson J, Spilker JA, on behalf of the American Heart Association Council on Cardiovascular Nursing and the Stroke Council et al (2009) Comprehensive overview of nursing and interdisciplinary care of the acute ischemic stroke patient: a scientific statement from the american heart association. Stroke 40(29):1129–1144Google Scholar
  25. 25.
    Sacco S, Stracci F, Cerona D, Ricci S, Carolei A (2011) Epidemiology of stroke in Italy. Int J Stroke 6:219–227PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Sara Mazzucco
    • 1
  • Giulia Turri
    • 1
  • Rina Mirandola
    • 2
  • Paolo Bovi
    • 3
  • Giulia Bisoffi
    • 2
  • Verona Hospital Stroke Study Group
  1. 1.Department of Neurological, Neuropsychological, Morphological and Motor Sciences, Section of Clinical NeurologyUniversity of VeronaVeronaItaly
  2. 2.Biostatistical UnitUniversity Hospital of VeronaVeronaItaly
  3. 3.Department of Neurosciences, Stroke UnitUniversity Hospital of VeronaVeronaItaly

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