Abstract TP266: Patient and Bystanders Perceived Seriousness of Stroke Symptoms at Onset

Background: Prehospital delay has several causes, most of them being patient-dependent. Knowledge of how patients and bystanders actually experience and react to symptoms at onset are essential. Purpose: Our aim is to characterize symptoms described by patients and bystanders at onset, perceived symptom seriousness, and whether this was associated with calling EMS directly. Methods: A cross-sectional study of consecutive acute stroke and TIA patients admitted at two stroke centres in the Central Denmark Region, in a three months period in 2018. Structured interviews of pre-stroke independent patients and bystanders were performed separately. Questions were open-ended. Symptoms identified as indicating stroke were classified as being focal or non-focal and perceived seriousness as mild or moderate/severe. Analysis were performed using logistic regression analysis. Results: A total of 1210 patients had a stroke/TIA in the period, of these 469 were included. We performed 654 interviews of patients and/or bystanders in median 1 day after stroke admission. Most frequent recognized symptoms by patients were limb palsy (31%), speech difficulties (26%) and dizziness (21 %). For bystanders: speech difficulties (47%), limb palsy (39%) and facial palsy (26%). Of patients and bystanders, 29 % and 23 % could not describe at least one focal symptom at onset. Focal symptoms were perceived as more serious in both patients and bystanders, OR (95% CI) 2.2 (1.29-3.76) and 2.61 (1.32-5.14). Patients who perceived symptoms as serious were more likely to make a direct EMS call, OR 2.10 (1.23-3.61). For bystanders, symptoms perceived as serious, were strongly associated with a direct EMS call: OR 22.7 (3.05-169.61). In patients being alone at stroke onset (98 (21%)) only 16% were able to call EMS directly and median (IQR) stroke severity (Scandinavian Stroke Scale) was lower among those calling EMS directly 57(52-58) vs 51(43-52), p Conclusion: Approximately 1 in 3 patients did not recognize focal stroke symptoms, but when focal symptoms were recognized and perceived as serious, this was associated with direct EMS call. The role of a bystander is pivotal and bystanders role to step in of importance.