Discrepancy between theoretical knowledge and real action in acute stroke: self-assessment as an important predictor of time to admission

Ritter MA, Brach S, Rogalewski A, et al. Discrepancy between theoretical knowledge and real action in acute stroke: self-assessment as an important predictor of time to admission. Neurological Research. 2013;29(5):476-479.Background: Poor knowledge of stroke symptoms within the general population might be responsible for significant delay between symptom onset and hospital admission in most stroke patients. Methods: We prospectively evaluated whether theoretical knowledge about stroke influenced time to admission among 102 consecutive acute stroke patients using standardized questionnaires. We assessed in multiple logistic regression models the influence of theoretical knowledge (knowledge about stroke symptoms and knowledge about the appropriate actions to be taken in the case of a stroke) on the real actions taken in the acute situation. Predictors of a delayed hospital admission greater than 2 hours after stroke onset were determined. Models were adjusted for age, gender, level of education, stroke severity, previous history of stroke or transient ischemic attack (TIA), and being alone at symptom onset. Results: Patients arrived significantly later, if the patients themselves were the managers of the emergency situation [odds ratio (OR): 4.7; 95% confidence interval (CI): 1.5–140.8]. Symptom knowledge and action knowledge were not found to be significantly associated with shorter pre-hospital times, whereas the correct diagnosis of stroke by the manager (OR: 0.2; 95% CI: 0.1–0.4) and calling the emergency medical system (OR: 0.3; 95% CI: 0.1–0.7) independently led to a higher likelihood to arrive at a hospital within 2 hours. Conclusion: Our study underscores that good theoretical knowledge about stroke does not imply appropriate management in the emergency situation. Educational efforts need to incorporate more practical aspects in order to translate theoretical knowledge into concrete action