A study of factors delaying hospital arrival of patients with acute stroke

Thrombolytic therapy for acute ischaemic stroke has recently become available in India but its success depends on initiating the treatment in the narrow therapeutic time window. There is commonly a delay of several hours before patients with acute stroke seek medical attention. A prospective study was conducted to assess the factors influencing this delay in admission of acute stroke cases. 110 cases (71 males, 39 females) of acute stroke that arrived within 72 hours at our hospital casualty were recruited. A standardized structured questionnaire was given to patients or their attendants. The median time to casualty arrival was 7.66 hours with 25% cases arriving within 3 hours and 49 % cases within 6 hours. Distance from hospital, contact with a local doctor and low threat perception of symptoms of stroke were independent factors associated with delay in arrival. Living in city, presence of family history and older age were associated with early arrival. There was no correlation with patients' or attendants' sex, educational status, history of previous stroke or transient ischaemic attack, subtype or severity of stroke, time of stroke and availability of transport. Adequate measures need to be taken to improve the public awareness of stroke and the role of local doctors.