While improvements are being made to acute stroke treatment at Dunedin Hospital, getting patients to recognise stroke symptoms and seek urgent help is still a major issue, Dr Brendon Rae says.
Too often, people were inclined to think they might have a pinched nerve and "sleep on it" rather than call an ambulance.
While people might worry they were making a fuss about something that might not be serious, Dr Rae said they would "feel more stupid if paralysis put them in a rest home".
Stroke Foundation of New Zealand chief executive Mark Vivian agreed there was a lack of awareness of stroke symptoms.
The foundation has been keen to see a national television campaign on the issue.
New Zealand research in 2007 found that while four out of five people realised stroke was a medical emergency, only a little more than a third could recognise one symptom of the condition.
Some also made the mistake of believing it was something which only affected old people, whereas about a quarter of strokes affected people under 65.
Dr Rae, who is Dunedin Hospital's internal medicine clinical leader, considered the services offered at the hospital would compare "quite reasonably" with those in the rest of the country.
He was commenting on the recently published national audit of acute hospital stroke services, based on information gathered before the hospital's stroke unit was set up last year.
Things took a long time to change and resources were limited, he said.
The unit had been set up "with the smell of an oily rag" from within the existing budget.
The audit was restricted to 40 patients' notes and an organisational survey of district health boards, which differed from an audit of care, which could have given more full information.
The audit, carried out by the Stroke Foundation of New Zealand for the Ministry of Health, found that only eight of the then 21 health boards provided stroke services consistent with international practice and only 39% of patients received care in a stroke unit.
Mr Vivian said the speed with which stroke patients were treated needed to be improved.
One area of concern was the number of people getting time-critical intravenous treatment to break down blood clots in the first four and a-half hours of stroke onset.
The audit, which looked at patient records for part of 2008, showed that while 67% of boards offered this treatment, only 3% of stroke patients were actually receiving it.
Dr Rae said this treatment, called thrombolysis, has only been offered at Dunedin Hospital in about the past two months.
Dunedin Hospital, unlike most of the hospitals at the time of the study, has an arrangement with the ambulance service to give advance warning to the emergency department if a suspected stroke patient is on the way.
The audit report also showed the use of aspirin, to thin the blood, within 48 hours for patients was "surprisingly low" at 21% nationally.
Dr Rae said Dunedin, in the past, would have been on a par with the rest of the country in this.
One of the reasons was that patients were often unable to take medication because they had difficulty swallowing.
There was, however, a medication (cardiprin) which could be placed in the mouth and which dissolved in saliva.
The audit showed the assessment of mini-strokes or transient ischaemic attacks (TIAs) was better than in Australian hospitals.
Dr Rae said the referrals to Dunedin's TIA clinic showed there was increased awareness among general practitioners.
The hospital was about to launch "The acute stroke pathway - time is brain", a trial document which would set out how patients should be dealt with, Dr Rae said.
The main advantage of this would be that it would help remind all those looking after stroke patients of all the steps required in their care, including such things as ensuring patients were referred to the Stroke Foundation when they returned home.
Large studies showed stroke units made a big difference to patient outcomes, but Dr Rae indicated that because the Dunedin unit was on a smaller scale, seeing 200 to 300 patients a year, the benefits were likely to be less obvious.
Mr Vivian said the audit was not designed to "blame and shame" any boards, but would allow them to compare their own results against the national picture.
He hoped the Minister of Health would note the need for extra resources for boards to improve services.
Stroke was a significant cost to the country not only because of the number of deaths, but also because it was the major cause of adult disability.
SYMPTOMS
For stroke recognition remember FAST.-
Face: Is your smile lopsided, with one side of your face droopy?
Arms: When you raise both arms in front of your body, is one weaker than the other?
Speech: Are you struggling to say a simple sentence or make sense of others' speech when sober?
Time: Time to dial 111 and get to hospital fast, if you have any of the above symptoms. Lost time could be lost brain function.
STROKES IN NEW ZEALAND
Stroke is the third largest killer in New Zealand, with more than 2000 deaths a year.
• Every day 21 New Zealanders have a stroke.
• Almost 8000 people in New Zealand suffer strokes each year.
• Mini-strokes (transient ischaemic attacks, or TIAs) can precede a stroke. While the symptoms can disappear quickly, medical treatment should be sought so a severe stroke might be avoided.
• About 2000 strokes each year occur in people below retirement age.
• Helpline: 0800-STROKE (78-76-53).
Source: Stroke Foundation of New Zealand
