Patient delay in patients suspected of TIA

Patient delay in patients suspected of TIA Purpose: Patients who suffer a Transient Ischemic Attack (TIA) have a high short-term risk of developing an ischemic stroke, being highest within the first 48 hours following TIA. Timely reporting of symptoms by patients and adequate diagnosis of TIA by physicians would enable urgent preventive treatment. We want to determine the extent and causes of patient delay in patients suspected of TIA. Methods: We conducted a survey at two rapid-access TIA outpatient clinics in Utrecht, the Netherlands, between July and September 2013. Patients suspected of TIA and referred to the outpatient clinic were interviewed. We determined the exact time from onset of symptoms to contacting a physician, most often the general practitioner. Additionally, we gathered demographic and clinical characteristics of participants, and behavioural aspects and knowledge on TIA of them were assessed. We used logistic regression to analyse predictors of patient delay. Results: A total of 45 patient suspected of TIA were interviewed. The median time until contacting a physician was 19 hours (IQR 0.54-82 h), and in 18 (40%) patients the delay was more than 24 hours. In our preliminary dataset the following factors were associated with a longer delay (>24h): (1) patient did not consider the symptoms being urgent; (2) patient did not consider TIA as a medical emergency; (3) no speech problems. Conclusions: Patients suspected of TIA show substantial delay in contacting a physician, being most often a general practitioner. Both symptoms suggestive of TIA and the disease TIA itself are not considered as being urgent by patients, with as a result postponement of critically important stroke prevention including treatment with antiplatelets. Lay persons need to be informed about the importance of recognizing TIA and early start of treatment.