Reduction of Prehospital Delays in Stroke and Transient Ischaemic Attack (TIA)

Study Overview
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Brief Summary
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In patients with acute stroke, systemic thrombolysis needs to be administered within three hours of symptom onset. The aim of the present study was to reduce prehospital delays in a population-based intervention.The intervention consisted of an educational letter indicating stroke symptoms and emphasizing the importance of calling the emergency medical services (EMS). The investigators additionally included a bookmark and sticker with the EMS telephone number. A total of 75,720 inhabitants received the intervention. Between 2004 and 2005, 741 patients with cerebrovascular events were admitted from the control areas (n=24) and 647 from the intervention areas (n=24).

Detailed Description
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Background and Purpose: In patients with acute stroke, systemic thrombolysis needs to be administered within three hours of symptom onset. The aim of the present study was to reduce prehospital delays in a population-based intervention. Methods: We performed a cluster-randomized trial with 48 zip code areas as cluster units in the catchment area of three inner-city hospitals in Berlin. The primary endpoint was time between symptom onset and hospital admission. The intervention consisted of an educational letter indicating stroke symptoms and emphasizing the importance of calling the emergency medical services (EMS). We additionally included a bookmark and sticker with the EMS telephone number. We fitted a lognormal survival regression model (time-to-admission) with frailty terms shared by inhabitants of the same zip code area.

Official Title
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Population-Based Intervention to Reduce Prehospital Delays in Patients With Stroke and Transient Ischaemic Attack

Conditions
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Stroke

Intervention / Treatment
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* Behavioral: educational material


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients with stroke or transient ischaemic attacks from the postal code areas of the study being admitted to one of the participating hospitals Exclusion Criteria: Patients with stroke or transient ischaemic attacks from outside the postal code areas of the study

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Intervention group<br>Educational letter indicating stroke symptoms and emphasizing the importance of calling the emergency medical services (EMS) as well as a bookmark and sticker with the EMS telephone number. | Behavioral: educational material<br>* Educational letter indicating stroke symptoms and emphasizing the importance of calling the emergency medical services (EMS) as well as a bookmark and sticker with the EMS telephone number.<br>|
| No Intervention: Control group<br>No intervention was performed | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time between symptom onset and hospital admission |  | Admission to hospital | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patients with thrombolysis |  | hospital stay | 
| Mortality |  | hospital stay | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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prehospital delays, intervention, population-based, stroke