Public Stroke Knowledge: Does a Link Exist Between the Presence of Risk Factors and Knowledge of Warning Signs

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Zachary Jarou, Nathaniel Harris, Liza Gill, Meena Azizi, Shayef Gabasha, Robert LaBril, Michigan State University College of Human Medicine Special Thanks to Henry Barry MD, Clare Luz PhD, Carlos Rios MPH ScD, Department of Family Medicine

Background & Purpose
Stroke is the third leading cause of death and the primary cause of severe, long-term adult disability in the United States, placing a signi cant burden on the health care system. Despite the availability of thrombolytic drugs, only 1-8% of ischemic stroke patients in the US are treated, with 73% of patients being excluded secondary to delay in seeking medical attention after the onset of stroke symptoms. The purpose of this survey is to determine if there is a correlation between the number of stroke risk factors that an individual has and their ability to correctly identify the warning signs of an ongoing stroke.

Results
The median age of respondents was 40, with a range from 18 to 88 years old.

Methods
This study (MSU IRB x13-139e) used a 17 item multiple-choice, cross-sectional survey administered to 245 members of the public, completed at grocery stores and malls in a medium-size university town in the Midwest. The survey included 6 symptoms (knowledge items) that subjects had to identify as being warning signs of a stroke (yes/no/unsure), 7 questions about their medical history that have been identi ed as modi able risk factors for developing a stroke (yes/no/maybe), and 4 demographic questions (age, gender, level of education, use of primary care physician). Data was analyzed using Stata (version 12) to estimate the prevalence of each risk factor within the sample population (Table 1), as well as the frequency of the sample population to unambiguously identify whether each proposed symptom could be considered a warning sign of a stroke (Table 2). Mean number of correct stroke symptom reponses and standard deviations were calculated for a number of subgroups by gender, level of education, and number of self-reported stroke risk factors. Comparison of stroke knowledge by gender was performed using a t-test, while comparison by level of education and by number of self-reported risk factors were both performed using ANOVA (Table 3). Multivariate regression analysis was also performed to estimate the independent contribution of individual variables on the ability to unambiguously recognize the warning signs of stroke (Table 4).

Conclusions
This study suggests that individuals with an increased number of modi able stroke risk factors are less able to correctly identify stroke warning signs compared to healthier individuals. The results also suggest that some stroke symptoms are more easily recognizable to the public than others. These ndings should be replicated in larger and more representative samples before developing future stroke awareness campaigns.

References
AHA Statistical Update: Heart Disease and Stroke Statistics 2011; 123:e18-e209. Following completion of the survey, participants were provided the correct answers to the stroke symptoms on the survey, as well as F.A.S.T. education. For more information, please visit www.strokeassociation.org. Barber et al. Why are stroke patients excluded from TPA therapy? An analysis of patient eligibility. Neurology 2001; 56:1015-1020. Kleindorfer et al. Temporal Trends in Public Awareness of Stroke Warning Signs, Risk Factors, and Treatment. Stroke 2009, 40:2502-2506.