Time to treatment and preventive antibiotics in stroke

Stroke is caused by cerebral ischaemia or intracerebral haemorrhage. Delay in stroke treatment after onset of symptoms and infections during the first days after stroke onset are associated with worse outcome. Haemorrhagic stroke in patients using vitamin K antagonists (VKA) has a poor outcome. Delay in antagonizing VKA in these patients is present in earlier studies.
With a qualitative study, we explored patient-related factors causing delay in seeking help after stroke onset. About half of the patients undertook no action after onset of symptoms. Knowledge or recognition of stroke symptoms were not associated with shorter alarm-time. Many participants had no interest in gaining knowledge about stroke symptoms or treatment options. Many participants would like to resolve the problems by themselves, not wanting to bother somebody or complaining easily. Future stroke-campaigns should be changed with less emphasis on knowledge, but based on input from population-embedded focus groups.
We studied whether a shorter in-hospital delay in treatment with prothrombin complex concentrate in VKA-related haemorrhagic stroke was associated with better functional outcome. We found, that a shorter delay was associated with a worse functional outcome, because severely affected patients were treated with less delay.
We studied whether preventive use of ceftriaxone improves functional outcome after 3 months. Ceftriaxone did not result in a beneficial effect. The rate of urinary tract infections was reduced, but not the pneumonia-rate. Despite these results a cost-effectiveness study showed that the intervention seems cost-effective in at least 66% of patients.