March/April - West Virginia State Medical Association

Scientific Article |
imprecision in the study estimates
(i.e. the proportion giving the
incorrect answer in the population
could be anywhere between 17%
and 44%, or even outside of these
interval limits). However, the goal
of this exploratory study was to
estimate a proportion different
from the most conservative guess
of 50% (essentially a coin flip)
given that this proportion was
previously unknown, and our power
calculations were based on this goal.
The relatively low response
rate could have also introduced
non-respondent bias, although
this response rate is comparable
to another recent random survey
examining a similar topic. 8 The
results may also not be applicable to
countries outside of the United States,
and regional differences may exist.
There may also have been some
bias introduced by the fact that
deception was not employed in the
study design (i.e. callers were told
that this call was part of a research
project). However, the decision was
made to not employ deception to
yield results similar to the study
by Jarrell et al. 2 in which healthline
operators affiliated with academic
neurology programs were also
informed of the research nature
of the call prior to participating.
The fact that both studies still
found an incorrect advice answer
in approximately one fourth to
one third of the calls is concerning
given the vast amount of research
confirming that stroke patients
who access the emergency medical
services system arrive at the ED
faster, which contributes to less
overall presentation delay. 8,9-14
Conclusion
Despite the majority of PCP office
respondents being able to name one
stroke sign or symptom, almost one
third recommended scheduling an
appointment later in the day for a
hypothetical stroke case. In contrast,
100% gave the correct answer of ‘call
911’ to a classic heart attack scenario.
Triaging potential stroke patients
away from emergent care may
result in stroke patient presentations
outside of the therapeutic treatment
windows. These results suggest
that stroke education with specific
emphasis on the need to call 911
may be needed for PCP office
receptionists. Further studies should
also examine the advice given by
other healthcare ‘entry points’, such
as pharmacies and the internet.
References
1. Hills NK, Johnston SC. Why are eligible
thrombolysis candidates left untreated
Am J Prev Med. 2006 Dec;31(6 Suppl 2):
S210-6. Epub 2006 Nov 7.
2. Jarrell B, Tadros A, Whiteman C, Crocco T,
Davis SM. National healthline responses to
a stroke scenario: implications for early
intervention. Stroke. 2007 Aug;38(8):2376-
8. Epub 2007 Jul 5.
3. California Acute Stroke Pilot Registry
(CASPR) Investigators. Prioritizing
interventions to improve rates of
thrombolysis for ischemic stroke.
Neurology. 2005 Feb 22;64(4):654-9.
4. Kothari RU, Pancioli A, Liu T, Brott T,
Broderick J. Cincinnati Prehospital Stroke
Scale: reproducibility and validity. Ann
Emerg Med. 1999 Apr;33(4):373-8.
5. Wein TH, Staub L, Felberg R,
Hickenbottom SL, Chan W, Grotta JC,
Demchuk AM, Groff J, Bartholomew LK,
Morgenstern LB. Activation of emergency
medical services for acute stroke in a
nonurban population: the T.L.L. Temple
Foundation Stroke Project. Stroke. 2000
Aug;31(8):1925-8.
6. Moser DK, Kimble LP, Alberts MJ, 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;114:168--82.
7. 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 Jan-Feb;36(1):25-34.
8. Mandelzweig L, Goldbourt U, Boyko V,
Tanne D. Perceptual, social, and
behavioral factors associated with delays
in seeking medical care in patients with
symptoms of acute stroke. Stroke. 2006
May;37(5):1248-53. Epub 2006 Mar 23.
9. Jurkowski JM, Maniccia DM, Dennison BA,
Samuels SJ, Spicer DA. Awareness of
necessity to call 9-1-1 for stroke
symptoms, upstate New York. Prev
Chronic Dis. 2008 Apr;5(2):A41. Epub
2008 Mar 15.
10. Rossnagel K, Jungehülsing GJ, Nolte CH,
Müller-Nordhorn J, Roll S, Wegscheider K,
Villringer A, Willich SN. Out-of-hospital
delays in patients with acute stroke. Ann
Emerg Med. 2004 Nov;44(5):476-83.
11. Kothari R, Jauch E, Broderick J, Brott T,
Sauerbeck L, Khoury J, Liu T. Acute stroke:
delays to presentation and emergency
department evaluation. Ann Emerg Med.
1999 Jan;33(1):3-8.
12. Bohannon RW, Silverman IE, Ahlquist M.
Time to emergency department arrival and
its determinants in patients with acute
ischemic stroke. Conn Med. 2003
Mar;67(3):145-8.
13. Morris DL, Rosamond W, Madden K,
Schultz C, Hamilton S. Prehospital and
emergency department delays after acute
stroke: the Genentech Stroke Presentation
Survey. Stroke. 2000 Nov;31(11):2585-90.
14. Lacy CR, Suh DC, Bueno M, Kostis JB.
Delay in presentation and evaluation for
acute stroke: Stroke Time Registry for
Outcomes Knowledge and Epidemiology
(S.T.R.O.K.E.). Stroke. 2001 Jan;32(1):63-9.
OFFICE MANAGERS ASSOCIATION
OF HEALTHCARE PROVIDERS, INC.
www.officemanagersassociation.com
We invite you to join our organization which consists of members
who manage the daily business of healthcare providers.
Our objectives are to promote educational opportunities, professional knowledge
and to provide channels of communication to office
managers in all areas of healthcare. We currently have
eleven chapters in West Virginia.
OFFICE MANAGERS ASSOCIATION
OF HEALTHCARE PROVIDERS, INC.
www.officemanagersassociation.com
We invite you to join our organization which consists of members
who manage the daily business of healthcare providers.
Our objectives are to promote educational opportunities, professional knowledge
and to provide channels of communication to office
managers in all areas of healthcare. We currently have
eleven chapters in West Virginia.
We invite you to join our organization which consists of members who manage the daily business of healthcare
providers. Our objectives are to promote educational opportunities, professional knowledge
Visit us on and our website for to more provide information or contact channels of communication to office managers in all areas of healthcare.
Donna Zahn (President) at 740-283-4770 ext. 105 or
Tammy Mitchell (Membership) at 304-324-2703. We currently have eleven chapters in West Virginia.
Visit us on our website for more information or contact
Donna Zahn (President) at 740-283-4770 ext. 105 or
Tammy Mitchell (Membership) at 304-324-2703.
28 West Virginia Medical Journal