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Salud Pública de México

versión impresa ISSN 0036-3634

Salud pública Méx vol.62 no.2 Cuernavaca mar./abr. 2020  Epub 28-Feb-2022

https://doi.org/10.21149/10783 

Cartas al editor

Symptom attribution in ischemic stroke: a strategy to increase thrombolysis rate

Atribución de síntomas en el accidente cerebrovascular isquémico: una estrategia para aumentar la tasa de trombólisis

Alejandro González-Aquines1 

Adolfo C Cordero-Pérez1 

Gil Pérez-Vázquez1 

Mario Cristobal-Niño1 

Denisse Martínez-Roque1 

Fernando Góngora-Rivera1 

1 Departamento de Neurología, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León. Nuevo León, México.


Dear editor: In Mexico, stroke is responsible of 620.24 disability-adjusted life years per 100 000.1Despite its public health relevance, stroke is unknown by most of the population.2Correct symptoms attribution has been suggested to influence timely hospital arrival. We evaluated symptom attribution in ischemic stroke patients and its influence in a timely arrival to receive thrombolytic therapy.

We included patients with ischemic stroke who were admitted to the University Hospital Dr. José E. González from January 2018 to April 2019. Data was obtained from an ongoing stoke registry (i-ReNe). Attribution of symptoms was asked as an open-ended question. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS). The study was approved by the Ethics and Research Committee (NR18-0002) from our Institution and participants gave verbal informed consent to participate.

A total of 309 subjects were included, 196 (63.4%) were males. Mean age was 61.02 (±13.4) and years of education was 7.26 (±4.2). Most common cardiovascular risk factors were sedentarism (65%) and hypertension (58.3%), while the most frequent clinical manifestations were upper (80.5%) and lower limb weakness (77.6%). At admission, most of the patients (59.7%) had a moderate stroke severity (NIHSS: 5-15). Attribution of symptoms was reported in 274 (table I) and only 66 (24%) correctly attributed their symptoms to stroke. Those who attributed their symptoms to stroke were more likely to receive intravenous thrombolysis, even after adjusting for age, sex and NIHSS (p=0.018; OR 2.849, 95%CI 1.196-6.787).

table I Characteristics of the population and answer to the open-ended question regarding attribution of symptoms 

N= 309 (%)
Age 61.02 ± 13.4
Sex, males 196 (63.4)
Years of education 7.26 ± 4.2
To what disease or condition did you attribute your symptoms when they started?*
Stroke 66 (24)
Hypertension 32 (11.6)
Fatigue 14 (5.1)
Dizziness 10 (3.6)
Diabetes 8 (2.9)
Myocardial infarction 7 (2.5)
Infection 6 (2.1)
Hypoglycemia 4 (1.4)
Other causes 65 (23.7)
Could not attribute to a disease 62 (22.6)

* Information about attribution of symptoms was reported by 274 patients.

Correct attribution of symptoms in ischemic stroke is related to a greater thrombolysis rate. Further, less than 25% of patients attributed their symptoms to stroke, which is concordant with previous reports.3

We encourage Mexican Health Authorities to promote stroke educational campaigns with a targeted population, such as the campaignChécate, mídete, muévete, which has been accepted and well received by the objective population.4 Health authorities, together with non-profit organizations, such as the Mexican Association of the Cerebrovascular Disease (Amevasc, by its acronym in Spanish) and academic institutions must work together to foster knowledge of stroke and correct interpretation of symptoms to increase the thrombolysis rate and reduce the disability after stroke.

References

1. GBD 2016 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1260-344. https://doi.org/10.1016/S0140-6736(17)32130-X [ Links ]

2. Góngora-Rivera F, González-Aquines A, Muruet W, Barrera-Barrera S, Leal-Bailey H, Espinosa-Ortega MA, et al. Difference in stroke knowledge between rural and urban communities in a developing country after community-based stroke educational campaigns: Results from a cross-sectional study. Neuroepidemiology. 2018;51(3-4):224-9. https://doi.org/10.1159/000490724 [ Links ]

3. Mata J, Frank R, Gigerenzer G. Symptom recognition of heart attack and stroke in nine European countries: a representative survey. Health Expect. 2014;17(3):79-96. https://doi.org/10.1111/j.1369-7625.2011.00764.x [ Links ]

4. Salazar-Coronel AA, Martínez-Tapia B, Mundo-Rosas V, Gómez-Humarán IM, Uribe-Carvajal R. Conocimiento y nivel de comprensión de la campaña Chécate, Mídete, Muévete en adultos mexicanos. Salud Publica Mex. 2018;60(3):356-64. https://doi.org/10.21149/8826 [ Links ]

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