Factors associated with prehospital delay in stroke: A multicentre study from eastern India

Background and objectives Prehospital delay is a significant challenge in stroke management. Our study aims to identify factors associated with prehospital delay in stroke. Methods This cross-sectional study was conducted between March 2024 and May 2024 across thirteen hospitals in West Bengal, India. Patients with acute stroke (both ischaemic and haemorrhagic) aged 18 year or above who consented to participate were consecutively surveyed using a structured questionnaire. Arrival at the study hospitals more than 4.5 h after symptom onset was considered as prehospital delay. Results Out of 683 patients with stroke, 389 (56.9%) arrived more than 4.5 h after symptom onset. Factors linked to delayed arrival included: distance over 15 km [Adjusted Odds Ratio (aOR) 2.55, 95% Confidence interval (CI) 1.56-4.16], lack of awareness about the 'golden hour of stroke' (aOR 11.01, 95% CI 4.29-28.26), nighttime onset (aOR 1.81, 95% CI 1.16-2.82), being alone at symptom onset (aOR 11.33, 95% CI 4.65-27.59), wake-up stroke (aOR 2.06, 95% CI 1.15-3.67), use of public transport (aOR 3.05, 95% CI 1.42-6.55), family history of stroke (aOR 2.01, 95% CI 1.11-3.61), vertigo (aOR 2.3, 95% CI 1.03-5.15), and visiting another treatment facility (aOR 6.52, 95% CI 4.21-10.12). Interpretation and conclusions Over half of stroke patients arrive late due to various factors. Increasing awareness about stroke and the 'golden hour' is vital to reduce prehospital delays.