Jennifer Pary

A Randomized, Controlled Trial to Teach Middle School Children to Recognize Stroke and Call 911 The Kids Identifying and Defeating Stroke Project

Background and Purpose— Underutilization of acute stroke therapy is driven by delay to hospital arrival. We present the primary results of a pilot, randomized, controlled trial to encourage calling 911 for witnessed stroke among middle school children and their parents. Methods— This project occurred in Corpus Christi, an urban Texas community of 325 000. Three intervention and 3 control schools were randomly selected. The intervention contained 12 hours of classroom instruction divided among sixth, seventh, and eighth grades. Parents were educated indirectly through homework assignments. Two-sample t tests were used to compare pretest and posttest responses. Results— Domain 1 test questions involved stroke pathophysiology. Intervention students improved from 29% to 34% correct; control students changed from 28% to 25%. Domain 2 test questions involved stroke symptom knowledge. Intervention school students changed from 28% correct to 43%; control school students answered 25% correctly on the pretest and 29% on the posttest. Domain 3 test questions involved what to do for witnessed stroke. Intervention school students answered 36% of questions correctly on the pretest and 54% correctly on the posttest, whereas control students changed from 32% correct to 34%. A comparison of change in the mean proportion correct over time between intervention and control students was P<0.001 for each of the 3 individual domains. A poor parental response rate impaired the ability to assess parental improvement. Conclusions— A scientific, theory-based, educational intervention can potentially improve intent to call 911 for stroke among middle school children. A different mechanism is needed to effectively diffuse the curriculum to parents.

Kids Identifying and Defeating Stroke (KIDS): Development and Implementation of a Multiethnic Health Education Intervention to Increase Stroke Awareness Among Middle School Students and Their Parents

The Kids Identifying and Defeating Stroke (KIDS) project is a 3-year prospective, randomized, controlled, multiethnic school-based intervention study. Project goals include increasing knowledge of stroke signs and treatment and intention to immediately call 911 among Mexican American (MA) and non-Hispanic White (NHW) middle school students and their parents. This article describes the design, implementation, and interim evaluation of this theory-based intervention. Intervention students received a culturally appropriate stroke education program divided into four 50-minute classes each year during the sixth, seventh, and eighth grades. Each class session also included a homework assignment that involved the students’ parents or other adult partners. Interim-test results indicate that this educational intervention was successful in improving students’ stroke symptom and treatment knowledge and intent to call 911 upon witnessing a stroke compared with controls. The authors conclude that this school-based educational intervention to reduce delay time to hospital arrival for stroke shows early promise.

Does Clinical-CT ‘Mismatch’ Predict Early Response to Treatment with Recombinant Tissue Plasminogen Activator?

Background:We hypothesized that patients with clinically severe strokes but less severe early ischemic changes on brain CT (i.e., clinical-CT mismatch) may respond better to intravenous recombinant tissue plasminogen activator (i.v. rt-PA) within 3 h of symptom onset. Methods: In this secondary analysis of the CLOTBUST data, patients with middle cerebral artery occlusions on transcranial Doppler (TCD) were treated with i.v. rt-PA. Alberta Stroke Program Early CT Scores were obtained with raters blinded to the NIH Stroke Scale and TCD results. Two mismatch criteria and three criteria of response to therapy were explored. Results: Of 126 patients, 67% had a mismatch type 1 and 74% had a mismatch type 2. The presence of clinical-CT mismatch by either definition did not correlate with any of the three criteria of response to rt-PA. Recanalization was a strong determinant of response, whether or not mismatch was present. Conclusions: Mismatch between severity of neurological deficit and CT findings is common but does not predict response to rt-PA therapy given within 3 h.

Transient ischemic attack (TIA)

©2008 The Prudential Insurance Company of America 751 Broad Street, Newark, NJ 07102-3777 Rx016 IFS-A005232 Ed. 10/08 Exp. 10/10 FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC. A transient ischemic attack is a brief focal neurologic deficit that resolves without any permanent neurologic impairment. Most cases are due to a small cerebral embolism or transient thrombosis (clotting) of a cerebral or carotid artery in an individual with underlying atherosclerotic disease. Others may be caused by emboli from the heart or elsewhere in the vascular system. An attack may last for a few minutes or a few hours, but ultimately it disappears without any residual neurologic impairment. Symptoms and signs such as numbness, weakness, dizziness, fainting, vision defects or aphasia (difficulty with speech) are typical of TIA and usually lead to the diagnosis. However, because of the fleeting nature of attacks, the physicians diagnosis is made in most cases from history alone, rather than by physical exam or laboratory testing. Follow-up testing, such as carotid studies and head CT or MRI scans may reveal evidence of atherosclerotic disease or previous stroke. These tests cannot rule out that a TIA occurred.