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1 Supplementary Online Content Wolters FJ, Li L, Gutnikov SA, Mehta Z, Rothwell PM. Medical attention seeking after transient ischemic attack and minor stroke in relation to the UK Face, Arm, Speech, Time (FAST) public education campaign: results from the Oxford Vascular Study. JAMA Neurol. Published online July 2, doi: / jamaneurol efigure. Flow Chart of Case Ascertainment in OXVASC etable 1. Baseline Characteristics of Patients With a First in Study TIA or Stroke etable 2. Delay in Presentation and Choice of First Contact With Healthcare Services in Relation to Patients Perception of Symptoms in TIA and Minor Stroke etable 3. Patient Perception of TIA and Minor Stroke Symptoms Before and After Initiation of the FAST Campaign etable 4. Reasons for More Than 3 Hour Delay in Seeking Medical Attention This supplementary material has been provided by the authors to give readers additional information about their work.
2 efigure. Flow Chart of Case Ascertainment in OXVASC The Oxford Vascular Study (OXVASC) is a population based study of all acute vascular events, including stroke and TIA in 92,728 individuals of all ages registered with 100 collaborating primary care physicians in nine general practices in the Oxfordshire, United Kingdom. Multiple overlapping methods are used to achieve near complete ascertainment of all care seeking individuals with stroke or TIA (defined in accordance with WHO and NINDS criteria as rapidly developed clinical sign of focal or global disturbance of cerebral function, lasting less than 24 hours, with no apparent non vascular cause). These include: 1) a daily TIA and stroke clinic to which participating general practitioners (GPs) and the local emergency department refer individuals with suspected TIA or stroke whom they would not normally admit directly to hospital; 2) daily searches of admissions to hospital wards and emergency department attendance; 3) monthly searches of GP diagnostic coding and hospital discharge codes; 4) monthly searches of all carotid imaging studies performed in local hospitals; 5) daily contact with hospital bereavement officers to identify patients brought into hospital dead or who died soon after arrival, and review of all death certificates in the study practices and ICD10 vascular death codes from the local Department of Public Health. A flow chart of case ascertainment procedure is presented above. The John Radcliffe Hospital serves as the primary referral site for acute stroke care in the study area, and the study TIA clinic receives >95% of outpatient referrals with TIA in the study population.
3 etable 1. Baseline Characteristics of Patients With a First in Study TIA or Stroke Pre-FAST (n=1231) Post-FAST (n=1012) P-value Age (mean SD) 74.1 ( 12.9) 73.1 ( 13.9) 0.07 Female sex 638 (51.8) 488 (48.2) 0.09 Caucasian ethnicity 1093 (96.5) 747 (96.0) 0.61 Past medical history Hypertension 668 (55.9) 564 (56.3) 0.85 Diabetes 138 (11.5) 148 (14.8) 0.02 Hyperlipidaemia 385 (34.5) 295 (33.9) 0.78 Current smoking 188 (15.6) 152 (15.5) 0.98 Atrial fibrillation 218 (18.3) 187 (18.7) 0.81 Myocardial infarction 88 (7.6) 94 (9.4) 0.13 Peripheral vascular disease 84 (7.0) 42 (4.2) Socioeconomic status, IMD * (median, IQR) 7.6 ( ) 7.6 ( ) 0.76 Presenting study TIA/stroke NIHSS (mean SD) ** 5.0 ( 6.7) 5.3 ( 7.1) 0.59 ABCD 2 4 *** 246 (58.6) 179 (54.1) 0.21 Duration in minutes (median, IQR) *** 30 (10-150) 30 (10-180) 0.91 Weekend occurrence 347 (28.2) 267 (26.4) 0.34 SD = standard deviation; * Index of multiple deprivation a higher score reflects a higher level of deprivation; NIHSS = National Institutes of Health stroke scale; IQR = interquartile range; ** stroke only; *** TIA only Characteristics are presented of the non-imputed data. Missing data were imputed using fivefold multiple imputation. This (Bayesian) procedure creates multiple copies of the dataset, replacing the missing values by imputed values on the basis of the observed data. Standard statistical methods are then applied to fit the model of interest to each of the imputed datasets, and subsequently averaged to give overall estimated associations. Of covariates included in the regression models, we had missing data for ethnicity (14.8%), socioeconomic status (8.7%), cohabiting (5.4%), NIHSS/ABCD 2 scores (4.9%), and onset during sleep (12.2%).
4 etable 2. Delay in Presentation and Choice of First Contact With Healthcare Services in Relation to Patients Perception of Symptoms in TIA and Minor Stroke Correct perception (%) Incorrect perception (%) OR [95% CI] p-value Time to seeking medical aid <3 hours 241 (55.0) 337 (38.1) REFERENCE 3-24 hours 101 (23.1) 255 (28.8) 0.55 [ ] < days 57 (13.0) 140 (15.8) 0.57 [ ] days 39 (8.9) 153 (17.3) 0.36 [ ] < First medical aid Emergency 130 (28.4) 193 (20.4) 1.55 [ ] Non-emergency 328 (71.6) 689 (79.6)
5 etable 3. Patient Perception of TIA and Minor Stroke Symptoms Before and After Initiation of the FAST Campaign Pre-FAST (%) Post-FAST (%) Post- versus pre- FAST Correct (%) Incorrect (%) Correct (%) Incorrect (%) OR [95% CI] P-value TIA & minor stroke 289 (37.3) 485 (62.7) 178 (27.6) 467 (72.4) 0.64 [ ] FAST-negative 60 (23.0) 201 (77.0) 49 (18.5) 216 (81.5) 0.76 [ ] 0.20 FAST-positive 220 (44.9) 270 (55.1) 129 (34.5) 245 (65.5) 0.65 [ ] TIA 149 (39.3) 230 (60.7) 100 (30.7) 226 (69.3) 0.68 [ ] 0.02 Minor stroke 140 (35.4) 255 (64.6) 78 (24.5) 241 (75.5) 0.59 [ ] TIA ABCD 2 <4 51 (33.8) 100 (66.2) 37 (27.4) 98 (72.6) 0.74 [ ] 0.24 ABCD (41.7) 123 (58.3) 45 (30.4) 103 (69.6) 0.61 [ ] 0.03 Isolated symptoms Motor 54 (57.4) 40 (42.6) 20 (32.8) 41 (67.2) 0.36 [ ] Speech 24 (32.9) 49 (67.1) 19 (31.1) 42 (68.9) 0.92 [ ] 0.83 Other 34 (20.1) 135 (79.9) 31 (17.0) 151 (83.0) 0.81 [ ] 0.46 OR= odds ratio; CI = confidence interval. Patient perception of the event was classified correct, when the symptoms were attributed to stroke, mini-stroke, or TIA. Isolated symptoms refer to events with only one type of focal symptom present (i.e. motor, sensory, speech, visual, or vertigo)
6 etable 4. Reasons for More Than 3 Hour Delay in Seeking Medical Attention TIA & MINOR STROKE (N=654) TIA (N=306) MINOR ISCHAEMIC STROKE (N=311) Reason for delay N (%) Reason for delay N (%) Reason for delay N (%) Other self-diagnosis 157 (24.0) (Awaiting) improvement 83 (27.1) Other self-diagnosis 101 (29.0) (Awaiting) improvement 153 (23.4) Not worried 65 (21.2) Not worried 80 (23.0) Not worried 145 (22.2) Other self-diagnosis 56 (18.3) (Awaiting) improvement 70 (20.1) Out-of-hours 50 (7.6) Out-of-hours 26 (8.5) Out-of-hours 24 (6.9) Pending appointment 30 (4.6) Pending appointment 23 (7.5) No idea about the cause 18 (5.2) No idea about the cause 29 (4.4) No idea about the cause 11 (3.6) Not to bother others 10 (2.9) Not to bother others 20 (3.1) Not to bother others 10 (3.3) Pending appointment 7 (2.0) Other 70 (10.7) Other 32 (10.5) Other 38 (10.9)
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