Embarrassed to Call Ambulance, Other Barriers to Stroke Treatment

APRIL 30, 2009
Ed Susman
Getting people who are having an acute stroke to the hospital in time for thrombolytic therapy—a window of opportunity that is about 3-4.5 hours wide—appears to be thwarted by a variety of barriers, including the desire of a the patient to avoid being embarrassed an ambulance showing up at the front door.

“Sometimes, patients just don’t seem to think their condition is serious enough to go to the hospital, or they think the symptoms will go away on their own,” said Amanda B. Castle, BA, a physician’s assistant student at Emory University in Atlanta, GA, in her poster, “Barriers in Seeking Early Stroke Treatment: Assessment of an Urban Underserved Population,” presented at the 61st Annual Meeting of the American Academy of Neurology.

Castle and colleagues at Washington Hospital Center in Washington, DC, interviewed 100 patients within 48 hours after being admitted to the hospital for stroke symptoms to ask them reasons for their delay in getting medical help. “Only 32% of the patients interviewed thought they were having a stroke,” Castle said.

Overall, 70% of the patients said that one reason for not seeking immediate help was that they didn’t think their symptoms were serious. She said that 68% of the patients thought their symptoms would get better without seeking medical help. About 29% of the patients said they didn’t call 911 because they would have been embarrassed to have emergency medical services and an ambulance appear at their home. About 23% of the people didn’t think that it would make any difference if they got to the hospital early or not. And 19% called their primary care physician first and waited for the doctor or a nurse to call back with instructions.

“These are very familiar reasons for failing to get treatment early,” said Andrew McKeon, MD, a fellow in neurology at the Mayo Clinic, Rochester, MN. “For many people, stroke is painless. When you have crushing chest pain, you tend to call for help more quickly.”

Dr. McKeon said that stroke patients who have sudden vision loss are more likely to call for an ambulance than those individuals who have a numbness or weakness in an arm, and put off calling for help until the stroke progresses to the point that they cannot walk or have other symptoms.

He said that continued education campaigns will be necessary to get patients to the hospital sooner so that they arrive within the window of opportunity for thrombolytic therapy.

“By identifying these barriers,” Castle said, “we can tailor interventions that have the potential to significantly increase the number of patients receiving effective acute therapies.”

She noted that only about 3-5% of stroke patients get to a hospital soon enough to even be eligible for thrombolytic treatment.

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