Reducing the Delay Between Stroke Onset and Hospital Arrival: Is It an Achievable Goal?

I n this issue of the Journal of the American Heart Association (JAHA), Addo and colleagues 1 report on prehospital delay by using data from the South London Stroke Registry, a highquality population-based acute stroke registry that collected data on more than 2000 first-time stroke events over a 9-year period between 2002 and 2010.Among the subset of 1392 out-of-hospital stroke events for which stroke onset-to-arrival (OTA) time data were available, the study found that almost 40% of cases arrived at 1 of the 5 registry hospitals within 3 hours of onset and that the overall median OTA time was 4.7 (interquartile range, 1.5 to 12.7) hours.Unfortunately, data were not presented by study year (ie, 2002 through 2010) to determine if there was any secular improvement in OTA times over this time period.Commendably, 11% of the 1085 ischemic stroke admissions in this study were treated with thrombolysis.In a multivariable logistic regression analysis of prehospital delay (defined as OTA >3 hours), the authors found that black ethnicity, living alone, and nighttime stroke onset were all associated with increased delay, whereas stroke severity was strongly associated with lower odds of delayed arrival.A further multivariable analysis of thrombolysis treatment was undertaken among all 1085 ischemic stroke admissions; the results identified age, ethnicity, and nighttime stroke onset as significant predictors, along with higher stroke severity, which was very strongly related to thrombolysis treatment (presumably because of its direct effects on OTA time).The study also reported on the impact of a 1-year national education campaign (based on the F.A.S.T. [face, arms, speech, and time] stroke assessment criteria) designed to educate the public on stroke signs and symptoms and the benefits of rapid treat-The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.