Time of onset decides eligibility, and the history you are given is almost never a time. It is a sequence of events. The way to convert it is to anchor to something the family can date rather than asking them to estimate: the end of a television programme, the call that came in, the time the food was served, the last message the patient sent or read.
A phone is the most reliable witness in the room. The timestamp of the last message the patient typed, the last call they answered coherently, or a step-counter that stops, all give a harder floor than recollection. Ask to see it rather than asking what time it was.
For wake-up strokes, last known well is when the patient was last seen normal - going to bed, not waking - but that no longer ends the conversation. Imaging-based selection now decides these cases, so the pathway is to establish the floor honestly, record it, and get the scan rather than to conclude ineligibility from the clock alone. Recording an uncertain time as uncertain, with the anchor you used, is more useful to the next clinician than a confident number nobody can trace.
- Anchor onset to a datable event, not to an estimate
- Ask to see the patient's phone - message and call timestamps beat recollection
- For wake-up stroke, record when last seen normal and proceed to imaging rather than excluding on time
- Write down which anchor you used, so the estimate can be revised rather than repeated
- Ask the first responder or ambulance crew separately; they often have a time nobody in the family recalls
Why it matters
Eligibility now turns on imaging as well as time, so a soft onset time is a reason to scan rather than a reason to stop.
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