Why Must You Get to a Hospital Immediately After a Stroke?

1 answer | Last updated: Aug 14, 2013
A fellow caregiver asked...

Why is it so important to get to the hospital within the "golden hour," or as soon as possible, to receive treatment for a stroke?

Expert Answers

Jeremy Payne, M.D., is the medical director of Banner Good Samaritan Stroke Center in Phoenix, Arizona.

Studies have consistently shown that if patients receive treatment within an hour after their stroke symptoms begin -- the period known as the "golden hour" -- they're much more likely to make a full recovery. Patients whose strokes require treatment with the clot-busting drug tissue plasminogen activator (known as tPA) must arrive at the hospital within one to three hours in order to be able to use the drug.

Unfortunately, we're still not doing as well as we should in getting patients to the hospital immediately after having a stroke. The American Heart Association (AHA) conducted a study this year of hospitals that are certified as part of the AHA's Get With the Guidelines-Stroke emergency program. The goal was to assess how quickly patients were getting to certified stroke centers and how quickly they were being treated once there. The results:

"¢ 40 percent of stroke victims arrived more than three hours after their symptoms started.

"¢ 32 percent arrived one to three hours after symptoms started.

"¢ 28 percent arrived within 60 minutes, or during the golden hour.

Part of the problem is that even if you get to the hospital right away, you can't be treated immediately. Multiple tests have to be performed first, including a brain scan. This is to make sure the cause of the stroke is a blocked artery rather than a hemorrhaging blood vessel. (Giving tPA for a blood vessel hemorrhage could cause more damage rather than less.)

Early treatment for stroke is critical because when a blood clot blocks blood flow to the brain, that part of the brain is deprived of oxygen. The result can be permanent damage. Doctors have a phrase for it: "Time lost is brain lost."

Getting treated right away reduces the chance of death by 21 percent in the immediate term and by an additional 18 percent over the following 12 months. Studies show patients who are treated right away also have shorter hospital stays and less need for institutional care.

So if you or someone you care for is concerned they might have had a stroke, rush to the emergency room right away. Once there, explain clearly that you think the cause of your symptoms was stroke, and request priority treatment to see a doctor.

The AHA study found that the time to treatment for patients who arrived at the hospital within the first hour was 15 minutes longer than the time to treatment for patients who arrived one to two hours after having a stroke, suggesting that hospitals themselves sometimes fail to act quickly enough during the golden hour.