Title : Time to treatment: Prospective observational study on prehospital delay in ischemic stroke patients

Background: Delayed prehospital times are a persistent challenge to early stroke treatment, especially within low- and middle-income settings. The search for determinants of delays to hospital presentation is important for optimizing acute stroke outcomes.

Objectives: Evaluation of the extent of prehospital delay and determination of factors related to delay in patients with acute stroke.

Methods: The hospital-based prospective study included consecutive patients admitted with acute stroke to a tertiary hospital in India. Sociodemographic, clinical, household, and health system factors were collected for all participants. The association of prehospital delay with categorical variables was studied using Chi-square or Fisher’s exact test as appropriate. Univariate logistic regression was used to compute odds ratios for 95% confidence intervals.

Results: One hundred forty-one patients participated, of whom 98 (69.5%) presented with prehospital delay. There is statistically significant difference between NIHSS score severity and patient experiencing prehospital delay. Logistic regression analysis in univariate logistic regression showed increased risk for prehospital delay for patients > 65 years, those without a bystander, or those not seeking immediate help. First contact in nonmedical college centers also was significant (p = 0.022) for prehospital delay. Patients' understanding of stroke symptoms or use of home remedies prior to seeking medical care was not significantly associated.

Conclusions: Prehospital delay in acute stroke is common and is strongly associated with social, situational, and health system–related factors. Strategies aimed at facilitating early bystander response, rapid seeking of assistance and streamlined referral pathways may reduce delays and improve access to timely stroke care. This study identifies modifiable factors contributing to prehospital delay in ischemic stroke, offering actionable insights to improve timely intervention and reduce stroke-related morbidity

Dr Archana Kurup is a resident in Government Medical College Thiruvananthapuram India, with a strong academic record. Her research experience includes studies on information processing speed among adolescents, safety and outcomes of cerebrovascular digital subtraction angiography, and the histomorphological spectrum of gliomas. She is currently involved in research on prehospital delays in ischemic stroke, focusing on implications for health systems and patient outcomes under the guidance of Dr Thomas Iype Head of the department of Neurology of Government Medical College Thiruvananthapuram India. Her academic interests lie in global health, epidemiology, and neuroepidemiology, with a particular emphasis on improving access to timely care and strengthening healthcare delivery systems in resource-limited settings.