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A systematic review of delays in seeking medical attention after transient ischaemic attack
  1. Nikola Sprigg (ns208{at}
  1. University of Leicester, United Kingdom
    1. Chipulwa Machili (cm242{at}
    1. University of Leicester, United Kingdom
      1. Mary Edmunds Otter (mleo1{at}
      1. University of Leicester, United Kingdom
        1. Andrew Wilson (aw7{at}
        1. University of Leicester, United Kingdom
          1. Thompson Robinson (tgr2{at}
          1. University of Leicester, United Kingdom


            Background: Prompt assessment, investigation and early initiation of secondary prevention after TIA are effective in reducing recurrent stroke. Despite this many patients are slow to seek medical advice.

            Objective: We performed a systematic review to examine potential factors associated with delay in seeking medical review after TIA.

            Design: Systematic review.

            Data-sources: Electronic databases MEDLINE, EMBASE, and Science Citation Index (December 1995 - September 2008).

            Review methods: Electronic searches were performed for observational studies assessing patient delay in presentation after TIA.

            Results: Electronic search yielded 9 studies with data on presentation delay in TIA patients; variations existed in study size, population and methodology. A single study included TIA patients only (n=241), whilst the remaining 8 studies recruited both stroke and TIA patients, with TIA patients (n=821) making up only a small proportion of the total patient number (n=3,202). Length of delay varied greatly across all studies; in most studies TIA patients to attending emergency department arrived there within hours. Where patients first presented to their general practitioner 50% attended within 24 hours, whilst 25% waited 2 days or more, and recognition of symptoms as stroke/TIA did not reduce delay.

            Conclusions: The majority of delay in seeking assessment is due to a lack of response by the patient; many patients do not recognise stroke/TIA symptoms, and even when they do, many fail to seek emergency medical attention. The public needs educating to contact the emergency medical services or attend ED immediately after TIA.

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