Factors Associated With Early Versus Late Hospital Arrival of Stroke Patients: A Cross-sectional Study

Abstract

Stroke is a leading cause of death and disability worldwide, with timely intervention being critical to minimizing long-term disability. Delays in hospital arrival frequently result in patients missing the therapeutic window for effective treatment. This study aimed to explore the factors contributing to delayed hospital arrival in acute stroke patients. METHODS: This cross-sectional study was conducted at a tertiary care hospital in the Arabian Gulf region, from February to November 2024. It included adults with computed tomography/magnetic resonance imaging-confirmed stroke, classified as early or late arrivers. Data collected included demographics, socioeconomic status, stroke symptoms and onset, risk factors, transportation method, post-stroke destination, and awareness of the emergency number and Alteplase (ALT). The National Institutes of Health Stroke Scale score at onset was recorded. RESULTS: Among 195 stroke patients, 46.15% arrived late. Significant differences between early and late arrivers were observed in employment, income, and stroke symptoms. Early arrivers had higher rates of limb weakness, facial weakness, and dysarthria/aphasia, whereas headache and vertigo were more common in late arrivers. Early arrivers were more likely to live with family or friends, be aware of ALT, and know the emergency number (P = 0.001, <0.001, <0.001, respectively). Knowledge of ALT [odds ratio (OR) = 5.63, 95% CI = 2.1-13.81] predicted early arrival, while headache (OR = 0.21, 95% CI = 0.04-0.97) and vertigo (OR = 0.17, 95% CI = 0.03-0.80) predicted delays. CONCLUSION: Lack of knowledge about ALT and unusual stroke symptoms is a potential barrier to early arrival within the therapeutic window. Strenuous efforts must be directed towards such barriers to achieve optimal care for patients with acute stroke.