Impediments Faced in Acute Stroke Care in Third World Countries - A Study from a Tertiary Center of South India

Stroke is a primary driver of global morbidity and mortality, exerting a profound toll on public health systems. Low-resource settings face challenges such as inadequate data, weak policies, and fragile healthcare infrastructure, leaving them ill-equipped to manage the growing stroke burden. The time from patient arrival to treatment initiation is a critical factor in determining outcome. This observational study aims to assess the cause of time delays and evaluate its impact by comparing outcome measures.

A bidirectional observational study was carried out among patients with acute stroke. Time taken for various treatment procedures, clinical outcomes using the National Institutes of Health Stroke Scale and Modified Rankin Scale scores, and factors contributing to delay were analyzed.

One hundred and seventeen patients were analyzed, with the maximum incidence among the 51-60-year group. Large artery atherosclerosis within the anterior circulation was the predominant subtype (64.1%). Only 45.3% arrived within the window period. Imaging was done for 37.6% of patients within 45 min of arrival. Delays occurred in computed tomography reporting (22.7%), thrombectomy workflow (18.2%), and patient stabilization (18.2%). Delay in arrival was primarily driven by poor symptom recognition (67.2%) and initial contact with nonstroke centers (27.6%). Treatment with antiplatelets alone demonstrated a statistically significant improvement as these were minor strokes. Thrombolysed patients showed improvement (8.47 ± 3.93-2.40 ± 1.68, P = 0.001) indicating efficacy. Thrombectomy exhibited improvement without statistical significance reflecting small sample size and severity.

Targeted interventions can be designed using the information obtained, including awareness campaigns and improved emergency response systems to improve stroke care.