Stroke warning campaigns: delivering better patient outcomes? A systematic review

Stroke warning campaigns: delivering better patient outcomes? A systematic review
DUBLIN – Patient delay in presenting to hospital with stroke symptoms remains one of the major barriers to thrombolysis treatment, leading to its sub-optimal use internationally. Educational interventions such as mass media campaigns and community initiatives aim to reduce patient delays by promoting the signs and symptoms of a stroke, but no consistent evidence exists to show that such interventions result in appropriate behavioral responses to stroke symptoms.
Methods – A systematic literature search and narrative synthesis were conducted to examine whether public educational interventions were successful in the reduction of patient delay to hospital presentation with stroke symptoms. Three databases, MEDLINE, CINAHL, and PsycINFO,were searched to identify quantitative studies with measurable behavioral end points, including time to hospital presentation, thrombolysis rates, ambulance use, and emergency department(ED) presentations with stroke.
Results – Fifteen studies met the inclusion criteria: one randomized controlled trial, two timeseries analyses, three controlled before and after studies, five uncontrolled before and after stud-ies, two retrospective observational studies, and two prospective observational studies. Studieswere heterogeneous in quality; thus, meta-analysis was not feasible. Thirteen studies examined prehospital delay, with ten studies reporting a significant reduction in delay times, with a variedmagnitude of effect. Eight studies examined thrombolysis rates, with only three studies report-ing a statistically significant increase in thrombolysis administration. Five studies examinedambulance usage, and four reported a statistically significant increase in ambulance transportsfollowing the intervention. Three studies examining ED presentations reported significantlyincreased ED presentations following intervention. Public educational interventions variedwidely on type, duration, and content, with description of intervention development largelyabsent from studies, limiting the potential replication of successful interventions.
Conclusions – Positive intervention effects were reported in the majority of studies; however,methodological weaknesses evident in a number of studies limited the generalizability of theobserved effects. Reporting of specific intervention design was suboptimal and impeded the identification of key intervention components for reducing patient delay. The parallel delivery of public and professional interventions further limited the identification of successful intervention components. A lack of studies of sound methodological quality using, at a minimum, a controlled before and after design was identified in this review, and thus studies incorporating a rigorousstudy design are required to strengthen the evidence for public interventions to reduce patientdelay in stroke. The potential clinical benefits of public interventions are far-reaching, and thechallenge remains in translating knowledge improvements and correct behavioral intentions toappropriate behavior when stroke occurs.
Lisa Mellon1
Frank Doyle1
Daniela Rohde1
David Williams2
Anne Hickey1
1 – Department of Psychology, RoyalCollege of Surgeons in Ireland, Dublin,Ireland;
2 – Department of Geriatric and Stroke Medicine, Royal College ofSurgeons in Ireland, Dublin, Ireland

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