Perceptual, social, and behavioral factors associated with delays in seeking medical care in patients with symptoms of acute stroke
Perceptual, social, and behavioral factors associated with delays in seeking medical care in patients with symptoms of acute stroke
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DOI：
10.1161/01.str.0000217200.61167.39
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发表时间：
2006-05-01
期刊：
影响因子：
8.3
通讯作者：
Tanne, D
中科院分区：
文献类型：
--
作者：
Mandelzweig, L;Goldbourt, U;Tanne, D
背景和目的-尽管急性缺血性卒中有再灌注治疗，但大多数患者仍然不符合条件，主要是因为住院时间较晚。我们假设知觉、社会和行为因素会影响出现症状后延迟寻求帮助的时间。方法：对出现中风症状的患者进行访谈，了解症状体验、解释和反应。结果：在209名患者(平均年龄61.8+/-12岁，69%的男性)中，从症状意识到寻求帮助的中位时间间隔为2(0.5~9)小时，到到达医院的中位时间间隔为4.2(1.3~14.5)小时。在多因素调整上，认为症状严重(优势比[OR]：0.42；0.17至0.95)、他人建议寻求帮助(OR：0.18；0.05至0.63)、联系救护车(OR：0.26；0.10至0.63)与延迟寻求帮助的风险降低有关，而感知对症状的控制(OR：2.45；1.08至5.71)会增加延迟寻求帮助的风险。女性延迟到达医院的风险是男性的3倍。患者延迟求医的比例随着综合危险因素的增加而增加，0到1和6到7个因素分别为17%到94%。结论：认知、社会和行为因素导致急性缺血性中风患者延迟就医的原因超出了人口统计学和临床变量，当综合起来时，进一步增加了延迟就医的风险。这些发现可能对设计减少延误的程序很重要。
Background and Purpose-Despite availability of reperfusion therapy for acute ischemic stroke, most patients remain ineligible mainly because of late hospital arrival. We hypothesized that perceptual, social, and behavioral factors affect delays in seeking help after symptom onset.Methods-Patients presenting with stroke symptoms were interviewed about symptom experiences, interpretations, and reactions. Odds ratios (95% CI) for risk of delay > 3 hours were estimated, and variables associated with increased risk and representing demographic, clinical, perceptual, social, and behavioral factors were included in an assessment of the effect of combined risk factors on delay.Results-Among 209 patients (mean age 61.8 +/- 12 years, 69% men) the median time interval from symptom awareness to seeking help was 2 (0.5 to 9) hours and to hospital arrival, 4.2 (1.3 to 14.5) hours. On multivariate adjustment, perceiving symptoms as severe (odds ratio [OR]: 0.42; 0.17 to 0.95), advice from others to seek help (OR: 0.18; 0.05 to 0.63), and contacting an ambulance (OR: 0.26; 0.10 to 0.63) were associated with decreased risks of delay, whereas perceived control of symptoms (OR: 2.45; 1.08 to 5.71) increased risk of delay in seeking help. Risk of delay in hospital arrival was 3 times greater in women than in men. Increasing proportions of patients who delayed seeking help were observed with increasing numbers of combined risk factors, ranging from 17% to 94% for 0 to 1 and 6 to 7 factors, respectively.Conclusions-Perceptual, social, and behavioral factors contribute to delay in seeking medical care in acute ischemic stroke beyond demographic and clinical variables, and, when combined, further increase risk of delay. These findings may be important for designing programs to reduce delay.