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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.
