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Sprigg, Nikola and Machili, C. and Otter, M.E. and Wilson, A. and Robinson, T.G. (2009) A systematic review of delays in seeking medical attention after transient ischaemic attack. Journal of Neurology, Neurosurgery and Psychiatry, 80 (8). pp. 871-885. ISSN 0022-3050

Abstract

Background: Prompt assessment and investigation of

transient ischaemic attack (TIA) followed by early

initiation of secondary prevention is effective in reducing

recurrent stroke. Nevertheless, many patients are slow to

seek medical advice after TIA. A systematic review was

undertaken to examine potential factors associated with

delay in seeking medical review after TIA.

Methods: The electronic databases MEDLINE, EMBASE,

and Science Citation Index were searched for observational

studies assessing patient delay in presentation after

TIA. The search was restricted to studies published

between December 1995 and September 2008.

Results: The electronic search yielded nine studies with

data on presentation delay in patients with TIA; variations

existed in study size, population and methodology. One

study included patients with TIA only (n=241), whereas

the remaining eight studies recruited both stroke and TIA

patients. Overall, TIA patients (n=821) made up only a

small proportion of the total number of patients in this

analysis (n=3,202). Length of delay varied greatly across

all studies. In most studies, patients with TIA who

attended an emergency department arrived there within

hours. Where patients first presented to their general

practitioner, 50% attended within 24 hours whereas 25%

waited 2 days or more. Recognition of symptoms as

stroke/TIA did not reduce the delay.

Conclusions: The majority of delay in seeking assessment

after TIA is due to a lack of response by the

patient—many patients do not recognise the symptoms

of stroke/TIA, and even when they do, many fail to seek

emergency medical attention. The public needs educating

on the importance of contacting the emergency medical

services or attending an emergency department immediately

after TIA.

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