Prevalence and factors influencing pre-hospital delays in patients with acute stroke

Background: Pre-hospital delay is one of the major factors that reduce the proportion of acute stroke patients receiving standard treatment, which can lead to lower probability of achieving a favorable outcome. We investigated the associated factors influencing pre-hospital delay among acute ischemic stroke patients in Thailand. Methods: We retrospectively reviewed medical records of patients with acute stroke treated in the emergency department of Songklanagarind Hospital between January 2014 to December 2018. Patients were classified into early (≤4.5 hours) and delayed (>4.5 hours) hospital arrival groups. Data on demographics, initial symptoms of acute stroke, and stroke severity, which was calculated using the National Institute of Health Stroke Scale (NIHSS), were collected. Results: A total of 381 subjects were included. The median age was 66 years [interquartile range (IQR), 55–77 years]. The median NIHSS score was 4 points (IQR, 2–9 points). The prevalence of pre-hospital delays was 45.7%. In the multivariate logistic regression analysis, the factors associated with a delayed arrival time were new-onset headache [odds ratio (OR), 2.42; 95% confidence interval (CI): 1.08–5.56], wake-up stroke (OR, 3.93; 95% CI: 1.82–8.98), and referral from other hospitals (OR, 11.0; 95% CI: 2.9–49.11), while moderate stroke (OR, 0.28; 95% CI: 0.12–0.58), severe stroke (OR, 0.35; 95% CI: 0.14–0.79), and using an ambulance to arrive at the hospital (OR, 0.31; 95% CI: 0.10–0.85) were significantly associated with an early hospital arrival time. Conclusions: The prevalence of pre-hospital delays following acute strokes was high among Thai stroke patients. Implementing a national stroke strategy to enhance community awareness of early stroke symptoms and promote increased utilization of ambulance services could foster early hospital arrival and improve stroke outcomes.