Stroke symptoms and the decision to call for an ambulance. 
Few acute stroke patients are treated with alteplase, partly because of significant prehospital delays after symptom onset.  The aim of this study was to determine among ambulance-transported stroke patients factors associated with stroke recognition and factors associated with a call for ambulance assistance within 1 hour from symptom onset.  For 6 months in 2004, all ambulance-transported stroke or transient ischemic attack patients arriving from a geographically defined region in Melbourne (Australia) to 1 of 3 hospital emergency departments were assessed.  Tapes of the call for ambulance assistance were analyzed and the patient and the caller were interviewed.  One hundred ninety-eight patients were included in the study.  Stroke was reported as the problem in 44% of ambulance calls.  Unprompted stroke recognition was independently associated with facial droop (P=0.015) and a history of stroke or transient ischemic attack (P<0.001).  More than half of the calls for ambulance assistance were made within 1 hour from symptom onset and only 43% of these callers spontaneously identified the problem as "stroke."  Factors independently associated with a call within 1 hour were: speech problems (P=0.009), caller family history of stroke (P=0.017), and the patient was not alone at symptom onset (P=0.018).  Stroke was reported as the problem (unprompted) by <50% of callers.  Fewer than half the calls were made within 1 hour from symptom onset.  Interventions are needed to more strongly link stroke recognition to immediate action and increase the number of stroke patients eligible for acute treatment.