Increasing trends in pre-transport stroke deaths--United States, 1990-1998.

OBJECTIVE We examined national trends in places where stroke deaths occurred. METHODS National vital statistics data (1990-1998) for stroke death (ICD-9 codes 430-438) were analyzed for place of death by selected socio-demographic characteristics and stroke subtype. RESULTS Half of all stroke deaths in 1998 occurred in-hospital, 46.1% occurred pre-transport, 0.6% were dead on arrival, and 3.3% occurred in the emergency department. Pre-transport deaths accounted for 55.0% of ischemic strokes, 12.8% of intracerebral strokes, and 12.9% of subarachnoid hemorrhagic strokes. The proportions of stroke deaths occurring pre-transport increased from 1990 through 1998 by 22.9% for all strokes, by 25.3% for ischemic, and by 24.3% for hemorrhagic stroke deaths. CONCLUSIONS Almost half of stroke deaths occur prior to hospital admission. Research must identify factors that promote more timely access to effective medical care. Further efforts are needed to increase public awareness about stroke symptoms in order to reduce both delays in seeking treatment, and untimely deaths from stroke.