ABSTRACT NUMBER: ESOC2026A1758 OPTIMIZING STROKE SYSTEMS OF CARE: IMPACT OF PREHOSPITAL NOTIFICATION ON ACUTE ISCHEMIC STROKE TIMELINES IN SAUDI ARABIA

Abstract Background and aims Timely reperfusion is critical in acute ischemic stroke, yet achieving recommended treatment timelines remains challenging. Prehospital notification by emergency medical services (EMS) has been proposed as an effective strategy to optimize in-hospital workflow. Data on its impact in Saudi Arabia remain limited. We aimed to evaluate the effect of a prehospital activation pathway on stroke care timelines in a tertiary center in Riyadh. Methods We conducted a retrospective observational study at King Fahad Medical City in 2022, following the implementation of an EMS prehospital notification pathway. Adult patients with acute ischemic stroke presenting within 3 hours of symptom onset were included. Patients were categorized into prenotification and no-prenotification groups. Demographic data, baseline NIHSS, intravenous thrombolysis (IVT) rates, and workflow metrics were extracted from electronic medical records and stroke nurse documentation. Statistical analyses were performed using SPSS. Results Among 695 eligible patients, 285 (41%) were managed with prehospital prenotification. IVT utilization was higher in the prenotification group compared with no prenotification (26% vs. 15.6%). Prenotification was associated with substantial reductions in door-to-CT time and door-to-needle time (median 22 vs. 47.5 minutes). A higher proportion of patients achieved door-to-needle times ≤60 minutes in the prenotification group (92% vs. 70%). Median onset-to-needle time was also significantly shorter with prenotification (115 vs. 158 minutes). Conclusions Implementation of a prehospital notification pathway significantly improved thrombolysis rates and reduced treatment delays in acute ischemic stroke. These findings support broader adoption of structured EMS prenotification systems to enhance stroke care delivery in Saudi Arabia. Conflict of interest All authors: nothing to disclose