Research article
Low public recognition of major stroke symptoms

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Abstract

Background

A Healthy People 2010 objective includes increasing public awareness of the warning signs of stroke, yet few data exist about the level of awareness. Recognition of stroke symptoms and awareness of the need to call 911 for acute stroke events were examined among the general population.

Methods

Data are from 61,019 adults participating in the 2001 Behavioral Risk Factor Surveillance System, a state-based telephone survey. Respondents indicated whether the following were symptoms of stroke: confusion/trouble speaking; numbness/weakness of face, arm, or leg; trouble seeing; chest pain (false symptom); trouble walking, dizziness, or loss of balance; and severe headache with no known cause. Persons also reported the first action they would take if they thought someone was having a stroke.

Results

Only 17.2% of respondents overall (5.9% to 21.7% by state) correctly classified all stroke symptoms and indicated that they would call 911 if they thought someone was having a stroke. Recognition of all symptoms and knowledge of when to call 911 were comparable by gender but lower among ethnic minorities, younger and older people, those with less education, and current smokers compared to whites, middle-aged people, those with more education, and nonsmokers, respectively. There were no substantive differences by history of hypertension, diabetes, heart disease, or stroke.

Conclusions

Public recognition of major stroke symptoms is low. Educational campaigns to increase awareness among the general population and targeted messages to those at high-risk persons and their families may help to improve time to treatment for adults suffering acute strokes.

Introduction

S troke remains a leading cause of death and a major cause of long-term disability, with about 700,000 people suffering a new or recurrent stroke each year in the United States.1, 2 Because stroke outcomes can be improved by timely care,3 it is important for the public as well as healthcare providers to recognize the major symptoms of stroke in order to initiate prompt action. Accordingly, a Healthy People 20104 objective includes increasing the proportion of people who are aware of the early warning signs of stroke. Several previous local and clinic-based studies and one statewide survey observed low recognition of the major stroke symptoms.5, 6, 7, 8 Larger studies of the general population were not found in the literature. Levels of public awareness of major stroke symptoms were examined in a state-based survey of adults in 17 states and the U.S. Virgin Islands.

Section snippets

Methods

The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based, random-digit-dialed telephone survey of adults aged≥18 years.9 Surveys include core questions asked of all participants and modules on specific public health topics of interest to particular state health programs. In 2001, a total of 62,632 persons in 17 states (Alabama, Arkansas, Colorado, Connecticut, Hawaii, Louisiana, Maine, Minnesota, Montana, Ohio, South Carolina, Tennessee, Utah, Virginia, West Virginia, Wisconsin,

Results

Most persons recognized the following signs as someone having a stroke: sudden confusion or trouble speaking (88%); numbness or weakness of the face, arm, or leg (94%); and sudden trouble walking, dizziness, or loss of balance (86%) (Table 1). Sudden trouble seeing in one or both eyes (68%) and severe headache with no known cause (61%) were less recognized as stroke symptoms. More than one third (38%) of persons, however, incorrectly classified sudden chest pain as a stroke symptom. About 86%

Discussion

Several factors, including rapid recognition of and reaction to stroke warning signs, start of prehospital care, emergency medical services (EMS) system transport and hospital pre-notification, and diagnosis and treatment at the hospital can increase one's chances of surviving an acute stroke.11 The effectiveness of “clot-busting” agents for acute ischemic stroke, for example, is increased if treatment is initiated within 3 hours of symptom onset.3 However, reports of prehospital delay time

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