Patients with milder symptoms, for whom treatment might be more effective, were less likely to arrive in time for therapy. This could be doubled by hypothesizing a 100% effect of educational efforts in reducing the delay in hospital arrival time.

The effectiveness of 17%, extrapolated with the aid of the odds ratio of 1.6 of having a favorable outcome (Barthel Index > or = 95 at 3 months) in treated versus untreated patients in the NINDS rt-PA Stroke Trial, corresponded to a projected clinical efficiency of 5%. Onset of symptoms when awake, drowsiness or coma, and paralysis of at least one limb were the only independent predictors of hospital arrival within 2 and 5 hours in both the total sample and the subgroup of patients who were awake at stroke onset.

The mean interval between onset of symptoms and hospital arrival was 680 minutes 59 patients (31%) arrived within 2 hours and 100 (53%) within 5 hours. We then projected the effectiveness of tissue plasminogen activator (TPA) on disability as estimated with the aid of the odds ratio from the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Trial onto our unselected sample to evaluate clinical efficiency of treatment as a function of arrival time and of hypothetical effects of educational efforts to reduce it. Exact multiple logistic regression was used to predict the delay as a function of dichotomized age, sex, symptoms on awakening, day of the week, hour of the day, area of residence, level of consciousness, and level of motor power defect. Cutoffs of 2 and 5 hours were chosen to allow for hypothetical treatment within 3 and 6 hours, respectively.

We evaluated the delay in hospital arrival time in 189 patients (84 men, 105 women mean age, 76.5 years) prospectively collected in the S Orsola-Malpighi Community Teaching Hospital in Bologna, Italy. A limiting criterion for the eligibility of patients in clinical trials investigating acute stroke therapies is that time between onset of symptoms and arrival in the hospital should fall within the 'therapeutic window.' The aims of this study were to estimate hospital arrival time in an unselected sample of stroke patients, to assess the association with some clinical and demographic variables, and to evaluate the effects of the delay on the clinical efficiency of an effective treatment.

After effects stroke effect