A multicentre observational study of presentation and early assessment of acute stroke

ObjectiveTo investigate delays in the presentation to hospital and evaluation of patients with suspected stroke.DesignMulticentre prospective observational study.Setting22 hospitals in the United Kingdom and Dublin.Participants739 patients with suspected stroke presenting to hospital.ResultsThe median age of patients was 75 years, and 400 were women. The median delay between onset of symptoms and arrival at hospital was 6 hours (interquartile range 1 hour 48 minutes to 19 hours 12 minutes). 37% of patients arrived within 3 hours, 50% within 6 hours. The median delay for patients using the emergency service was 2 hours 3 minutes (47 minutes to 7 hours 12 minutes) compared with 7 hours 12 minutes (2 hours 5 minutes to 20 hours 37 minutes) for referrals from general practitioners (P<0.0001). Use of emergency services reduced delays to hospital (odds ratio 0.45, 95% confidence interval 0.23 to 0.61). The median time to evaluation by a senior doctor was 1 hour 9 minutes (interquartile range 33 minutes to 1 hour 50 minutes) but was undertaken in only 477 (65%) patients within 3 hours of arrival. This was not influenced by age, sex, time of presentation, mode of referral, hospital type, or the presence of a stroke unit. Computed tomography was requested within 3 hours of arrival in 166 (22%) patients but undertaken in only 60 (8%).ConclusionDelays in patients arriving at hospital with suspected stroke can be reduced by the increased use of emergency services. Over a third of patients arrive at hospital within three hours of stroke; their management can be improved by expediting medical evaluation and performing computed tomography early.

What is already known on this topic

Delay in presentation and assessment of patients with suspected stroke prevents the possible benefits from thrombolysis being achievedLittle is known about the presentation and early management of patients with acute stroke in the United Kingdom

What this study adds

Most patients with suspected stroke in the United Kingdom arrive at hospital within six hours of the onset of symptomsNot all patients are evaluated by a senior doctor within three hours of arrival at hospital and most do not undergo computed tomographyThe potential for thrombolysis in patients with acute stroke can be improved significantly by greater use of emergency services and expediting evaluation and investigations by doctors     

Evaluation of coliforms as indicators of water quality in India

P.W. RAMTEKE, J.W. BHATTACHARJEE, S.P. PATHAK AND N. KALRA. 1992. The total and thermotolerant coliform counts in rural drinking water derived from ground water, piped supplies and surface water are reported for a number of areas in India. To evaluate these counts as indicators of recent faecal contamination the total coliforms and thermotolerant coliforms isolated have been identified. Thermotolerant Escherichia coli formed 11.7% of the total coliforms and 75.1% of the thermotolerant coliforms. Citrobacter sp. (20.4%) and Klebsiella sp. (50.9%) were the other common total coliforms isolated and, among the thermotolerant coliforms, Klebsiella sp. (16.4%) was the only other organism frequently encountered. The total coliform counts were significantly correlated with water temperature. The applicability in tropical areas of standards developed for temperate climates is discussed.