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The following links provide useful research to support Stroke Smart efforts.

  1. Many stroke patients do not receive life-saving therapy, ScienceDaily
    — Highlighting time to treatment delays (only 3.8% of ischemic stroke patients got tPA)

  2. Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke (PDF), AHA Scientific Statement

  3. Golden Hour Study (PDF), Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
    — Highlights the effectiveness of early stroke treatment

  4. Prehospital Delay Lack of improvement 2017 (PDF), frontiers in Neurology
    — Demonstrates that in the more than 2 decades medication has been available to treat strokes, many patients still do not access that effective treatment in time

  5. JAMA Neurology study (PDF) showing only 15% of patients get to tPA in time.

  6. Times from Symptom Onset to Hospital Arrival...Temporal Trends and Implications (PDF)
    — Shows that 75% of patients arrive too late.

  7. Barriers to Prompt Presentation to Emergency Departments in Colorado after Onset of Stroke Symptoms (PDF)
    — Shows 64% of patients don't get to treatment on time

  8. Activation of Emergency Medical Services for Acute Stroke in a Non-urban Population (PDF)
    — The study shows that less than 5% of stroke patients called 911 for themselves; only 38% of stroke patients overall arrived via EMS; the same study shows that 78% of patient arrive outside the treatment window.

  9. Time is Brain— Quantified (PDF), American Heart Association Study
    — "The typical patient loses 1.9 million neurons each minute in which stroke is untreated."

  10. Community Education Targeting a Middle East Population Improves Recognition of Stroke Signs and Onset to Door Times (PDF)
    — Surmounting cultural barriers to Stroke Smart training. A success story.

  11. A Neurosurgeon's Guide to Stroke Symptoms, Treatment and Prevention, American Association of Neurological Surgeons
    — Shows only 3 to 5% of stroke patients get to treatment in time.

  12. Child-mediated Health Communication (PDF), Journal of Health Disparities Research and Practice
    — A study showing the value of school-based stroke education programs. The children effectively become first responders, recognizing the signs of a stroke and calling 911. The children also transmit the knowledge to their parents, increasing community awareness overall even among adults. Click here.

  13. Global Burden of Stroke (PDF), University Hospital of Zurich
    — A study outlining the global burden of stroke is here.

  14. Kids Identifying and Defeating Stroke (PDF), NIH Public Access
    — A study showing that "educational intervention was successful in improving students’ stroke symptom and treatment knowledge and intent to call 911 upon witnessing a stroke compared with controls," is here.

  15. BE-FAST...Reducing the Proportion of Strokes Missed (PDF), American Heart Association
    — This study shows the results of adding "BE" to the "FAST" stroke sign acronym.

  16. Barriers and Disparities in Emergency Medical Services (PDF)
    — This study shows that "those less likely to call 911 were found in the following groups: 65 years or older, men, other race, unmarried, less than or equal to high school degree, less than $25,000 family income, uninsured, no PCP, burden of medical costs, fair/poor health, previous history of strokes, or interaction between burden of medical costs and less than $50,000 family income."

  17. Some studies suggest that even prior experience with suffering strokes does not convey to getting treatment in time for subsequent strokes:

  18. The Lifetime Risk of Stroke (PDF), American Heart Association
    — This study shows that the lifetime risk of stroke is 1 in 6.


  1. "The top three factors associated with delayed arrival [of stroke patients to the hospital] were if a general practitioner (GP) or primary care facility was visited first, referral from another hospital, and living alone."

    If time is brain, where is the improvement in prehospital time after stroke? By Jeremy N. Pulvers and John D. G. Watson, Frontiers in Neurology, Mini Review published: 20 November 2017. Read the article on the Frontiers website

  2. * 2008 International Stroke conference found that, in 22% of cases, a patient or bystander's first response to stroke symptoms was to call a doctor, not an ambulance.

    * A troubling study presented at the American Stroke Association's annual International Stroke Conference in February [2008] found that nearly a third of receptionists in primary care offices would, if talking to patients who reported classic stroke symptoms, direct them to come in for a visit later in the day, rather than telling them to call 911.

    Is your staff prepared to respond to a stroke? By J. Berthhold, ACP Internist. Read the article on the ACP Internist website

  3. Almost 1 in 3 patients with a diffusion-weighted magnetic resonance imaging–confirmed ischemic stroke first called the family doctor practice. Face-to-face visits to the family doctor quadrupled the odds of prehospital delay. Efforts to reduce prehospital delay should address family doctors and their staffs as important partners in the prehospital pathway. Reasons for Prehospital Delay in Acute Ischemic Stroke Joachim Fladt, MD, et. al, Journal of the American Heart Association, October 2019. Read the article on JAHA's website

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