Better stroke patient outcomes? A systematic review

What to do to have a better outcome in stroke patients? One of the solutions will start from the analysis of the patient delay in entering hospitals with stroke symptoms.

This seems to remain one of the major barriers to thrombolysis treatment, leading to its sub-optimal use internationally.

This article reports a study carried out in 2015 in Dublin. The aim of this research is the reduction in stroke patient delays by promoting the signs and symptoms of a stroke.

At the time, there was no consistent evidence exists to show that such interventions result in inappropriate behavioural responses to stroke symptoms.

Improving stroke patients’ medical outcome: methods

To examine whether public educational interventions were successful in the reduction of patient delay to hospital presentation with stroke symptoms, researchers conducted a systematic literature search and narrative synthesis They used data from MEDLINE, CINAHL, and PsycINFO databases.
The main aim was to identify quantitative studies with measurable behavioural endpoints. Among the endpoints, there was time to hospital presentation, thrombolysis rates, ambulance use, and emergency department (ED) presentations with stroke.

 

Stroke outcomes: results

Fifteen studies met the inclusion criteria: one randomized controlled trial, two time-series analyses, three controlled before and after studies, five uncontrolled before and after studies, two retrospective observational studies, and two prospective observational studies.
Studies were heterogeneous in quality; thus, a meta-analysis was not feasible. Thirteen studies examined prehospital delay, with ten studies reporting a significant reduction in delay times, with a varied magnitude of effect.
Eight studies examined thrombolysis rates, with only three studies reporting a statistically significant increase in thrombolysis administration. Five studies examined ambulance usage, and four reported a statistically significant increase in ambulance transports following the intervention.
Three studies examining ED presentations reported significantly increased ED presentations following the intervention. Public educational interventions varied widely on the type, duration, and content, with a description of intervention development largely absent from studies, limiting the potential replication of successful interventions.

Better stroke outcomes: conclusions

Positive intervention effects were reported in the majority of studies; however, methodological weaknesses evident in a number of studies limited the generalizability of the observed 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 the design was identified in this review, and thus studies incorporating a rigorous study design are required to strengthen the evidence for public interventions to reduce patient delay in stroke.
The potential clinical benefits of public interventions are far-reaching, and the challenge remains in translating knowledge improvements and correct behavioural intentions to appropriate behaviour when a stroke occurs.

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