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February 16

Kids improve grades on stroke recognition with new program

American Stroke Association press release

KISSIMMEE, Fla., Feb. 16 – The key to getting more emergency treatment for stroke patients may lie with children, researchers report today at American Stroke Association’s International Stroke Conference 2006.

You can learn about stroke just like the kids in the project did! Visit project K.I.D.S. for some interactive learning.

Initial results from a pilot program teaching middle-school students and their parents about stroke suggest that the program increases the intention of children to call 9-1-1 if they see someone having a stroke.  This is a key step to quickly getting treatment for stroke patients.

Researchers hope that children who are better informed about stroke will share the information with their parents and improve overall stroke awareness and preparedness to call emergency medical services (EMS).

The most effective therapies for stroke must be given within the first hours of stroke symptom onset.  Calling 9-1-1 immediately is the most crucial step in determining stroke outcome.  Few patients receive aggressive, early stroke treatment because they arrive at hospitals too late.

Seventh graders who received instruction in stroke awareness significantly improved their knowledge of stroke and their recognition of stroke symptoms. Those students were more likely to say they would call 9-1-1 upon witnessing stroke symptoms, compared to students who did not participate in the instructional program.

Dr. Morgenstern“We know the overwhelming reason that stroke patients do not get approved acute stroke therapy is because they don’t get to the hospital fast enough,” said senior researcher Lewis Morgenstern, M.D., professor of neurology and director of the stroke program at the University of Michigan in Ann Arbor.

To evaluate the impact of a school-based stroke education program, the National Institutes of Health funded the Kids Identifying and Defeating Stroke (KIDS) project.  KIDS is an ongoing study evaluating stroke education in three middle schools in Corpus Christi, Texas and includes 12 hours of instruction about stroke over three years as part of the students’ health or science curricula.

The two primary objectives of KIDS are to educate a new generation about stroke and to encourage more people to call 9-1-1 when witnessing stroke symptoms, which may increase appropriate use of acute stroke therapies; and encourage the students to communicate stroke information to their parents and guardians through homework assignments.  The idea is to increase their readiness and willingness to call 9-1-1 immediately upon witnessing a stroke. The training included hands-on activities and scenarios with interactive computer simulations.

The current data reports results after the first two years of the study.  Students completed a 12-question evaluation before instruction started and after the second year of instruction, and scores from the two tests were compared.  The questions were grouped into three general categories: 1) What is a stroke? 2) What are the signs of a stroke? 3) What do you do if a stroke occurs?

A total of 149 students who received stroke instruction (intervention) completed both evaluations, as did 182 students who did not receive the instruction (control).  In the intervention group, knowledge of stroke pathophysiology and treatment and recognition of stroke symptoms all improved; while the “intent to call 9-1-1 for a witnessed stroke improved substantially,” researchers said.  The intervention students improved more than the control students. 

A second study from the KIDS project attempted to identify factors that would influence parents’ decisions to call 9-1-1 if they witnessed someone who might be having a stroke. Students took assignments to their parents involving a scenario with a stranger and a scenario with a neighbor.

Fifty-one parents responded to the assignment.  The most commonly cited factor that would discourage parents from calling EMS was concern about “what if it isn’t a stroke,” mentioned by 30 parents.  Researchers interpreted the answer as reflecting a desire to avoid embarrassment.

Lead researcher, Kate Maddox, M.S., R.N., C.S., a nurse practitioner in the stroke program at the University of Michigan, said, “We’ve learned that people will call 9-1-1 when they are confident they have recognized stroke symptoms.  However, if they are unsure the patient is having a stroke, they won’t call 9-1-1 due to fear of embarrassment or incurring negative consequences stemming from activating EMS if it isn’t a stroke.  We need to teach people that they don’t have to diagnose the stroke themselves and they won’t get in trouble if they call 9-1-1 and it turns out to not be a stroke.”

Other factors that parents said would discourage them from calling 9-1-1 were a belief that the symptoms might improve and belief that someone else (such as the person’s relative or a more experienced individual) should decide whether to call EMS.  When teaching the public about stroke response, it needs to be clear that 9-1-1 should be called even when symptoms improve and that the person who recognizes stroke symptoms is the right person to make the decision to call 9-1-1.
Researchers will conduct follow up with students at the end of 8th grade and during high school.  The long term goal is to incorporate the stroke instruction into curricula around the country.

Other co authors are Kathleen Conley, Ph.D.; Nicole Gonzales, M.D.; Nina Espinosa, B.A.; James Grotta, M.D.; Jennifer J. Majersik, M.D.; Devin L. Brown, M.D.; Lemuel A. Moye, M.D. Ph.D.; Lynda D Lisabeth, Ph.D. and Jennifer K. Pary, M.D.

Written by Kara Gavin

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