Top

Published in:

Open Access 01-12-2019 | Stroke | Research article

Barriers from calling ambulance after recognizing stroke differed in adults younger or older than 75 years old in China

Authors: Shengde Li, Li-Ying Cui, Craig Anderson, Chunpeng Gao, Chengdong Yu, Guangliang Shan, Longde Wang, Bin Peng, on behalf of the FAST-RIGHT Investigators and Coordinators

Published in: BMC Neurology | Issue 1/2019

Abstract

Background

As health behavior varies with increasing age, we aimed to examine the potential barriers in calling emergency medical services (EMS) after recognizing a stroke among 40–74- and 75–99-year-old adults.

Methods

Data were obtained from a cross-sectional community-based study (FAST-RIGHT) that was conducted from January 2017 to May 2017 and involved adults (age ≥ 40 years) across 69 administrative areas in China. A subgroup of residents (153675) who recognized stroke symptoms was analyzed. Multivariable logistic regression models were performed in the 40–74 and 75–99 age groups, separately, to determine the factors associated with wait-and-see behaviors at the onset of a stroke.

Results

In the 40–74 and 75–99 age groups, the rates of participants who chose “Self-observation at home” were 3.0% (3912) and 3.5% (738), respectively; the rates of “Wait for family, then go to hospital” were 31.7% (42071) and 33.1% (6957), respectively. Rural residence, living with one’s spouse, low income (< 731 US $ per annum), having a single avenue to learn about stroke, and having friends with stroke were factors associated with waiting for one’s family in both groups. However, unlike in the 40–74 age group, sex, number of children, family history, and stroke history did not influence the behaviors at stroke onset in the 75–99 age group.

Conclusions

Different barriers from recognizing stroke and calling an ambulance exist in the 40–74 and 75–99 age groups in this specific population. Different strategies that mainly focus on changing the “Wait for family” behavior and emphasize on immediately calling EMS are recommended for both age groups.

Available only for authorised users

Yang G, Wang Y, Zeng Y, Gao GF, Liang X, Zhou M, et al. 2Rapid health transition in China, 1990-2010: findings from the global burden of disease study 2010. Lancet. 2013;381(9882):1987–2015. https://doi.org/10.1016/S0140-6736(13)61097-1.CrossRefPubMed

Guan T, Ma J, Li M, Xue T, Lan Z, Guo J, et al. Rapid transitions in the epidemiology of stroke and its risk factors in China from 2002 to 2013. Neurology. 2017;89(1):53–61. https://doi.org/10.1212/WNL.0000000000004056.CrossRefPubMed

Wang Y, Liao X, Zhao X, Wang DZ, Wang C, Nguyen-Huynh MN, et al. Using recombinant tissue plasminogen activator to treat acute ischemic stroke in China: analysis of the results from the Chinese National Stroke Registry (CNSR). Stroke. 2011;42(6):1658–64. https://doi.org/10.1161/STROKEAHA.110.604249.CrossRefPubMed

Jin H, Zhu S, Wei JW, Wang J, Liu M, Wu Y, et al. Factors associated with prehospital delays in the presentation of acute stroke in urban China. Stroke. 2012;43(2):362–70. https://doi.org/10.1161/STROKEAHA.111.623512.CrossRefPubMed

Saver JL, Smith EE, Fonarow GC, Reeves MJ, Zhao X, Olson DM, et al. The "golden hour" and acute brain ischemia: presenting features and lytic therapy in >30,000 patients arriving within 60 minutes of stroke onset. Stroke. 2010;41(7):1431–9. https://doi.org/10.1161/STROKEAHA.110.583815.CrossRefPubMedPubMedCentral

Fassbender K, Balucani C, Walter S, Levine SR, Haass A, Grotta J. Streamlining of prehospital stroke management: the golden hour. Lancet Neurol. 2013;12(6):585–96. https://doi.org/10.1016/S1474-4422(13)70100-5.CrossRefPubMed

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 guidelines for the early Management of Patients with Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46–e110. https://doi.org/10.1161/STR.0000000000000158.CrossRefPubMed

Moser DK, Kimble LP, Alberts MJ, Alonzo A, Croft JB, Dracup K, et al. Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: a scientific statement from the American Heart Association Council on cardiovascular nursing and stroke council. Circulation. 2006;114(2):168–82. https://doi.org/10.1161/CIRCULATIONAHA.106.176040.CrossRefPubMed

Fussman C, Rafferty AP, Lyon-Callo S, Morgenstern LB, Reeves MJ. Lack of association between stroke symptom knowledge and intent to call 911: a population-based survey. Stroke. 2010;41(7):1501–7. https://doi.org/10.1161/STROKEAHA.110.578195.CrossRefPubMed

10.

Yin X, Yang T, Gong Y, Zhou Y, Li W, Song X, et al. Determinants of emergency medical services utilization among acute ischemic stroke patients in Hubei Province in China. Stroke. 2016;47(3):891–4. https://doi.org/10.1161/STROKEAHA.115.011877.CrossRefPubMed

11.

Lundelin K, Graciani A, Garcia-Puig J, Guallar-Castillon P, Taboada JM, Rodriguez-Artalejo F, et al. Knowledge of stroke warning symptoms and intended action in response to stroke in Spain: a nationwide population-based study. Cerebrovasc Dis. 2012;34(2):161–8. https://doi.org/10.1159/000341408.CrossRefPubMed

12.

Yang J, Zheng M, Cheng S, Ou S, Zhang J, Wang N, et al. Knowledge of stroke symptoms and treatment among community residents in Western urban China. J Stroke Cerebrovasc Dis. 2014;23(5):1216–24. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.10.019.CrossRefPubMed

13.

Moreira E, Correia M, Magalhaes R, Silva MC. Stroke awareness in urban and rural populations from northern Portugal: knowledge and action are independent. Neuroepidemiology. 2011;36(4):265–73. https://doi.org/10.1159/000328867.CrossRefPubMed

14.

Soomann M, Vibo R, Korv J. Acute stroke: why do some patients arrive in time and others do not? Eur J Emerg Med. 2015;22(4):285–7. https://doi.org/10.1097/MEJ.0000000000000206.CrossRefPubMed

15.

Li S, Cui LY, Anderson C, Zhu S, Xu P, Wei T, et al. Public awareness of stroke and the appropriate responses in China: a cross-sectional community-based study (FAST-RIGHT). Stroke. 2019;50:455–62. https://doi.org/10.1161/STROKEAHA.118.023317.CrossRef

16.

Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990-2010: findings from the global burden of disease study 2010. Lancet. 2014;383(9913):245–54.CrossRef

17.

Zeng Y, Feng Q, Hesketh T, Christensen K, Vaupel JW. Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: a cohort study. Lancet. 2017;389(10079):1619–29. https://doi.org/10.1016/S0140-6736(17)30548-2.CrossRefPubMedPubMedCentral

18.

Guo C, Du W, Hu C, Zheng X. Prevalence and factors associated with healthcare service use among Chinese elderly with disabilities. J Public Health (Oxf). 2016;38(3):e345–e51. https://doi.org/10.1093/pubmed/fdv120.CrossRef

19.

National Center for Stroke Control and Prevention, National Health Commission. The China National Stroke Screening Survey Guidelines [online, in Chinese]. http://cnstroke.com/WebManage/InterveneProject/Index. (2016, accessed 23 March 2019).

20.

Longde W, Ling Y, Yang H, Yi Z, Yongjun W, Xunming J, et al. Fixed-dose combination treatment after stroke for secondary prevention in China: a national community-based study. Stroke. 2015;46(5):1295–300. https://doi.org/10.1161/STROKEAHA.114.007384.CrossRefPubMed

21.

Harbison J, Hossain O, Jenkinson D, Davis J, Louw SJ, Ford GA. Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test. Stroke. 2003;34(1):71–6.CrossRef

22.

Nordanstig A, Jood K, Rosengren L. Public stroke awareness and intent to call 112 in Sweden. Acta Neurol Scand. 2014;130(6):400–4. https://doi.org/10.1111/ane.12293.CrossRefPubMed

23.

Pandian JD, Jaison A, Deepak SS, Kalra G, Shamsher S, Lincoln DJ, et al. Public awareness of warning symptoms, risk factors, and treatment of stroke in Northwest India. Stroke. 2005;36(3):644–8. https://doi.org/10.1161/01.STR.0000154876.08468.a0.CrossRefPubMed

24.

Mosley I, Nicol M, Donnan G, Patrick I, Dewey H. Stroke symptoms and the decision to call for an ambulance. Stroke. 2007;38(2):361–6. https://doi.org/10.1161/01.STR.0000254528.17405.cc.CrossRefPubMed

25.

Teuschl Y, Brainin M. Stroke education: discrepancies among factors influencing prehospital delay and stroke knowledge. Int J Stroke. 2010;5(3):187–208. https://doi.org/10.1111/j.1747-4949.2010.00428.x.CrossRefPubMed

26.

Zerwic J, Hwang SY, Tucco L. Interpretation of symptoms and delay in seeking treatment by patients who have had a stroke: exploratory study. Heart Lung. 2007;36(1):25–34. https://doi.org/10.1016/j.hrtlng.2005.12.007.CrossRefPubMed

27.

Montaner J, Vidal C, Molina C, Alvarez-Sabin J. Selecting the target and the message for a stroke public education campaign: a local survey conducted by neurologists. Eur J Epidemiol. 2001;17(6):581–6.CrossRef

28.

Nedeltchev K, Fischer U, Arnold M, Kappeler L, Mattle HP. Low awareness of transient ischemic attacks and risk factors of stroke in a Swiss urban community. J Neurol. 2007;254(2):179–84. https://doi.org/10.1007/s00415-006-0313-x.CrossRefPubMed

29.

Pontes-Neto OM, Silva GS, Feitosa MR, de Figueiredo NL, Fiorot JA Jr, Rocha TN, et al. Stroke awareness in Brazil: alarming results in a community-based study. Stroke. 2008;39(2):292–6. https://doi.org/10.1161/STROKEAHA.107.493908.CrossRefPubMed

30.

Miyamatsu N, Okamura T, Nakayama H, Toyoda K, Suzuki K, Toyota A, et al. Public awareness of early symptoms of stroke and information sources about stroke among the general Japanese population: the Acquisition of Stroke Knowledge Study. Cerebrovasc Dis. 2013;35(3):241–9. https://doi.org/10.1159/000347066.CrossRefPubMed

31.

Campos-Sousa RN, Soares VY, Almeida KJ, Carvalho LI, Jacobina KS, Athayde Netto AE, et al. Knowledge of stroke among a Brazilian urban population. Arq Neuropsiquiatr. 2007;65(3A):587–91.CrossRef

32.

Cimarolli VR, Jopp DS. Sensory impairments and their associations with functional disability in a sample of the oldest-old. Qual Life Res. 2014;23(7):1977–84. https://doi.org/10.1007/s11136-014-0657-0.CrossRefPubMed

Title: Barriers from calling ambulance after recognizing stroke differed in adults younger or older than 75 years old in China
Authors: Shengde Li
Li-Ying Cui
Craig Anderson
Chunpeng Gao
Chengdong Yu
Guangliang Shan
Longde Wang
Bin Peng
on behalf of the FAST-RIGHT Investigators and Coordinators
Publication date: 01-12-2019
Publisher: BioMed Central
Keyword: Stroke
Published in: BMC Neurology / Issue 1/2019
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-019-1480-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Barriers from calling ambulance after recognizing stroke differed in adults younger or older than 75 years old in China

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2019

Isolated hypoglossal nerve palsy from internal carotid artery dissection related to PKD-1 gene mutation

Sexual dysfunction and associated factors among patients with epilepsy at Amanuel Mental Specialty Hospital, Addis Ababa – Ethiopia

Leukoencephalopathia, demyelinating peripheral neuropathy and dural ectasia explained by a not formerly described de novo mutation in the SAMD9L gene, ends 27 years of investigations – a case report

Inflammatory profiling of patients with familial amyloid polyneuropathy

Progressive stenosis and radiological findings of vasculitis over the entire internal carotid artery in moyamoya vasculopathy associated with graves’ disease: a case report and review of the literature

Does all single infarction have lower risk of stroke recurrence than multiple infarctions in minor stroke?