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REPLY
Delayed Hospital Arrival for Acute Stroke
Maureen A. Smith, MD, MPH;
Eyal Shahar, MD, MPH; and
Russell V. Luepker, MD, MS
16 February 1999 | Volume 130 Issue 4 Part 1 | Page 328
IN RESPONSE:
Dr. Lacy's comments underscore the importance of developing and testing new interventions to shorten delays from the onset of stroke symptoms to hospital admission. Their 1997 data are similar to our data for 1991 to 1993 and suggest that current limited approaches to public and provider education have not reduced delay. Comprehensive public and professional education programs seem to be effective (1), but the amount of education needed may be considerable. Patients at highest risk for stroke are a population of particular interest. However, a recent study suggested that persons at risk for stroke were generally unaware of their increased risk, and those at highest risk (the very elderly) were least knowledgeable (2). Strategies that target these high-risk persons should be examined, including interventions at the level of the community, the patient, and the provider. The cost-effectiveness of identifying and targeting high-risk patients should also be compared with the cost-effectiveness of broader efforts that target the general public.
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Author and Article Information
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University of Minnesota School of Public Health; Minneapolis, MN 55454-1015 (Smith)
University of Minnesota School of Public Health; Minneapolis, MN 55454-1015 (Shahar)
University of Minnesota School of Public Health; Minneapolis, MN 55454-1015 (Luepker)
1. Barsan WG, Brott TG, Broderick JP, Haley EC Jr, Levy DE, Marler JR. Urgent therapy for acute stroke. Effects of a stroke trial on untreated patients Stroke. 1994;25:2132-7.
2. Pancioli AM, Broderick J, Kothari R, Brott T, Tuchfarber A, Miller R, et al. Public perception of stroke warning signs and knowledge of potential risk factors JAMA. 1998;279:1288-92.
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- Annals 1998 129: 190-196.
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