ABSTRACT NUMBER: ESOC2026A2390 ACUTE STROKE CARE TIMELINES AND DETERMINANTS OF DELAYS IN PERIPHERAL AND REFERRAL HOSPITAL IN RESOURCES-LIMITED SETTING: A MULTICENTER CROSS-SECTIONAL STUDY

Abstract Background and aims Stroke is a major neurological emergency and a leading cause of mortality and morbidity Worldwide. This study aimed to evaluate prehospital and inhospital delays in acute stroke management in both peripheral and referral hospital in Cameroon. Methods A multicentre cross-sectional and analytical study has been conducted from November 2024 to June 2025, in 8 hospitals : 5 peripheral and 3 referral. Stroke patients aged 18 and above were consecutively recruited. We collected data on demographics, cerebrovascular risk factors, prehospital events, severity (NIHSS), time intervals (time intervals (onset-to-door, door-to-imaging, door-to-neurologist, initiation of adapted treatment), and outcomes. Logistic regression identified predictors of delays. Results A total of 256 patients were included (mean age 61±13 years; 52% women; 63% Hypertension). Overall, 71% of patients arrived >4.5h of symptoms onset. Lack of awarness of stroke urgency was predictor of late arrival (aOR: 8.66; p <0.001). Time to first medical evaluation exceeded 10 minutes in 40% of cases, with language impairment (aOR 6.33; p=0.001), body temperature >37.5°C (aOR 3.34; p=0.008), BMI >25 (aOR 2.36; p=0.047) and poor awareness of urgency (aOR 2.63; p=0.028) as predictors. Door-to-imaging exceeded 25min in 70% of cases in peripheral hospital. Minor stroke (NIHSS < 5) was independant predictor of imaging delay (aOR 6.32; p=0.022). Imaging delay independently predicted treatment delay (aOR 4.03; p=0.001). Consequently, 50% of patients were ineligible for thrombolysis by late arrival alone. Conclusions Significant delays exist at every stage of the acute care pathway in Douala, including symptom recognition, prehospital transport, imaging and neurological assessment. Conflict of interest This study was funded by Projet Amorce, supported by Academie de Recherche et d'Enseignement Supérieur, Belgique