Most African-Americans report calling a friend instead of 911 when faced with the symptoms of a stroke, according to a new study that surveyed those hospitalized for a stroke.
The findings, published online in the journal Stroke, indicate that most people, who didn't call for emergency help, believed their symptoms were not serious enough and/or did not require treatment.
The survey, conducted by researchers at Georgetown University Medical Center, is critical to understanding why many delay getting to a hospital where emergent care, such as tPA, can be administered. tPA, or tissue plasminogen activator, is designed to break up the blood clot in the brain causing the stroke. tPA can significantly reduce the effects of stroke and reduce permanent disability. A critical component to this treatment, however, is that tPA must be given to the patient within the first few hours of the stroke symptoms. So, a delay in treatment can mean the difference between serious side effects and full recovery.
"Previous studies have shown that fewer blacks receive tPA than whites, and one reason is that they're not getting to a hospital in time," explains Chelsea Kidwell, M.D., director of the Georgetown University Stroke Center. "We want to understand the reasons for these delays so we can focus our education campaigns in meaningful ways that will reduce this disparity."
The Georgetown researchers administered a survey to 253 community volunteers in the service areas of a large urban community hospital in the Washington, D.C. area. Concurrently, 100 structured interviews were conducted in the same hospital with acute stroke patients (or proxies.)
In this predominantly urban, black population, if faced with a hypothetical stroke, nearly 9 of every 10 community volunteers surveyed (89 percent) said they would call 911 first.
But in reality, more than seven of every 10 hospitalized of stroke patients interviewed -- or 75 percent-- called a friend or family member first.
"Most of those we surveyed at the hospital said they called a friend or a relative first when they realized something was wrong," says Kidwell. "When we drilled down a little further, we found that most thought their symptoms were not serious or that they would eventually resolve."
Of those who did call 911 for an ambulance, 25 percent say they did so because they thought it would be faster, while 35 percent said they had no other transportation option.
"It appears that current education campaigns are not fully achieving their goal in this community," explains Kidwell. "Many say they know the signs of a stroke, but there's a lag time in getting to the hospital. There is a gap between knowing what to do and actually doing it -- our current education campaigns focus an addressing this specific barrier by empowering the public to "be prepared for a stroke." Future campaigns will need to emphasize that time is of the essence -- people need to not only know the warning signs of a stroke but also the need to call 911 right away."
This research was supported by grants to Georgetown University from the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Minority Health and Health Disparities (NIMHD), both part of the National Institutes for Health. Kidwell reports no personal financial interest related to the study.
- Amie W. Hsia, Amanda Castle, Jeffrey J. Wing, Dorothy F. Edwards, Nina C. Brown, Tara M. Higgins, Jasmine L. Wallace, Sara S. Koslosky, M. Chris Gibbons, Brisa N. Sαnchez, Ali Fokar, Nawar Shara, Lewis B. Morgenstern, and Chelsea S. Kidwell. Understanding Reasons for Delay in Seeking Acute Stroke Care in an Underserved Urban Population. Stroke, 2011; DOI: 10.1161/STROKEAHA.110.604736
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