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Feb. 21, 2000 -- No.99
ER study shows half of stroke victims used EMS, were treated an hour earlier
By DAVID WILLIAMSON
UNC-CH News Services
CHAPEL HILL -- Half of 617 patients in a new study of stroke victims -- or someone helping them -- called 911 and arrived at the emergency room in an ambulance, according to a new University of North Carolina at Chapel Hill study. Those patients reached the hospital an average of an hour earlier than others and were more likely to be in time for treatment with newly approved clot-busting drugs. Many of those arriving by other means were too late to be helped by the drugs, which must be given within three hours of the first symptoms if they are to be effective.
"We also found that the most powerful predictor of who would use EMS was whether or not someone else was around the patient and identified a problem," said Dr. Wayne A. Rosamond, associate professor of epidemiology at the UNC-CH School of Public Health. "Surprisingly, we also found that people with better knowledge and access to information about strokes were no more likely than others to use EMS."
A report on the findings will appear in a medical journal later this year. Others involved in the research were epidemiology graduate student Emily Schroeder and Dr. Dexter Morris, vice chair and associate professor of emergency medicine at the UNC-CH School of Medicine.
"The bottom line is that programs to promote the use of EMS for stroke should consider targeting not only people at risk, but also people around them such as spouses and older children," Rosamond said. "Everyone needs to know that stroke should be treated as an emergency."
Titled "Delay in Accessing Stroke Healthcare," or DASH, the study involved researchers waiting in hospital emergency rooms for stroke patients to arrive and then briefly interviewing them or the people who brought them. Questions included whether they had called 911, who first identified the emergency, did they think the symptoms were urgent and did they know anything about stroke.
Only about half the patients could speak for themselves, Rosamond said. Researchers also followed them throughout their hospital stays. Other factors predicting EMS use were being younger and feeling that symptoms were urgent.
"The whole idea of getting to the hospital quickly after a stroke has become more important recently because in 1996 the U.S. Food and Drug Administration approved the first thrombolytic agents for treating those patients," he said. "Before then, there wasnt much anyone could do acutely for a person with stroke, and so the speed with which they got to emergency rooms was not so much of a factor."
Clot-busting drugs for stroke were approved only for use within the first three hours, Rosamond said. He and colleagues found it took an average of about four hours for patients to get to an emergency room, and it wasnt uncommon for six or more hours to have elapsed since symptoms began.
"Were trying to find out the reasons for the delays so that we can develop education programs or systems that can get people in quicker so they can get this therapy," he said.
Prompt treatment sometimes can prevent death or reduce brain damage associated with stroke, which deprives the brain of oxygen, either by blocking blood flow or internal bleeding, which has a similar effect but is treated very differently. Prompt CAT scans can show doctors which kind of stroke has occurred and help them determine a treatment.
Participating hospitals included UNC Hospitals in Chapel Hill; Greenville Memorial, Hillcrest and Allen Bennett hospitals in Greenville, S.C., and Denvers University and Exempla St. Joseph hospitals. Rosamond and colleagues presented an abstract about the study at a recent American Heart Association meeting in New Orleans.
Stroke symptoms include sudden dimness or loss of vision, weakness or numbness on one side of the body and sudden loss of clear speech.
"Were trying to get people to understand that since stroke is a very serious medical condition, 911 should be involved immediately," Rosamond said.
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Note: Rosamond can be reached at (919) 962-3230.
Contact: David Williamson, 962-8596.