Barriers to Early Hospital Presentation in Acute Stroke: Findings from a Cohort Study.

Abstract

Background and objectives: The time taken to transport patients for thrombolytic therapy in stroke cases remains alarmingly high, compromising potential positive outcomes. Addressing these delays can enhance prehospital care and improve patient prognoses.

Aim: This study aimed to identify factors causing delays in treating acute stroke patients at a tertiary care hospital in southern India, to inform better practices and expedite care.

Methods: Caregivers of ischemic stroke patients were interviewed about delays. Patients were divided into two groups: those who arrived within the critical four-and-a-half-hour window (Group A) and those who arrived later (Group B). Data collected included distance from home to hospital, transportation options, and mode of transport. A comparative analysis was performed between patients from stroke-ready facilities versus others, with data analyzed using SPSS software.

Results: The study included 594 patients, with 73.4% arriving outside the recommended window. Women represented one-third of the population overall and 20% in Group A. Younger patients arrived sooner (P < 0.0001). The main reason for delays was a lack of awareness of stroke symptoms (53.2%), followed by initial care sought at non-stroke-ready hospitals (23%). Use of ambulances and vehicle ownership significantly correlated with faster arrivals (P < 0.0001), while distance to the hospital did not significantly affect timeliness. Though most of the variables showed statistical significance between those coming to the hospital within and outside the four-and-a-half hour window with univariate analysis, none of the variables showed a significant association when subjected to logistic regression.

Conclusions: Delays in stroke treatment are a major concern, linked to factors like age, gender, and transportation issues. No single factor independently predicted early hospital arrival. To improve outcomes, we need strategies that enhance public education, symptom recognition, and transportation-especially for vulnerable groups like women and the elderly.