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A systematic review of delays in seeking medical attention after transient ischaemic attack

Sprigg, Nikola; Machili, C.; Otter, M.E.; Wilson, A.; Robinson, T.G.


Nikola Sprigg

C. Machili

M.E. Otter

A. Wilson

T.G. Robinson


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.

Journal Article Type Article
Publication Date Jan 1, 2009
Journal Journal of Neurology, Neurosurgery and Psychiatry
Print ISSN 0022-3050
Electronic ISSN 0022-3050
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 80
Issue 8
APA6 Citation Sprigg, N., Machili, C., Otter, M., Wilson, A., & Robinson, T. (2009). A systematic review of delays in seeking medical attention after transient ischaemic attack. Journal of Neurology, Neurosurgery and Psychiatry, 80(8), doi:10.1136/jnnp.2008.167924
Publisher URL
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf