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

A majority of stroke patients in the study arrived at the hospital after the critical treatment window.

• Out of 683 patients with stroke, 389 (56.9%) arrived more than 4.5 hours after symptom onset
• Arrival more than 4.5 hours after symptom onset was used as the definition of prehospital delay
• The study was conducted across thirteen hospitals in West Bengal, India between March 2024 and May 2024
• Both ischaemic and haemorrhagic stroke patients aged 18 years or above were included

Lack of awareness about the 'golden hour of stroke' was one of the strongest independent predictors of prehospital delay.

• Adjusted Odds Ratio (aOR) of 11.01 (95% CI 4.29–28.26) for lack of awareness about the 'golden hour of stroke'
• This was among the highest aORs of all factors examined in the study
• The finding underscores the importance of public education campaigns about stroke recognition and urgency

Being alone at symptom onset was the strongest single factor associated with prehospital delay.

• aOR of 11.33 (95% CI 4.65–27.59) for being alone at symptom onset
• This was the highest adjusted odds ratio among all factors analyzed
• The finding suggests that social isolation at the time of stroke onset significantly hinders timely help-seeking

Visiting another treatment facility before the study hospital was strongly associated with prehospital delay.

• aOR of 6.52 (95% CI 4.21–10.12) for visiting another treatment facility prior to arriving at the study hospital
• This was the third strongest factor associated with delay after being alone and lack of awareness
• This suggests that referral pathways and initial care-seeking behavior contribute substantially to delays

Use of public transport was significantly associated with prehospital delay.

• aOR of 3.05 (95% CI 1.42–6.55) for use of public transport compared to other modes of transport
• This factor likely reflects both access to emergency transport services and broader infrastructure challenges in the region

Living more than 15 km from the hospital was significantly associated with prehospital delay.

• aOR of 2.55 (95% CI 1.56–4.16) for distance over 15 km
• This highlights geographical barriers as an important contributor to delayed hospital arrival in eastern India

Nighttime onset of stroke symptoms was independently associated with prehospital delay.

• aOR of 1.81 (95% CI 1.16–2.82) for nighttime onset
• Wake-up stroke was also independently associated with delay, with an aOR of 2.06 (95% CI 1.15–3.67)
• Both findings suggest that circumstances limiting immediate recognition and response to symptoms contribute to late arrival

Family history of stroke and presenting with vertigo were also independently associated with prehospital delay.

• aOR of 2.01 (95% CI 1.11–3.61) for family history of stroke
• aOR of 2.3 (95% CI 1.03–5.15) for vertigo as a presenting symptom
• The association of vertigo with delay may reflect difficulty in recognizing it as a stroke symptom
• The association with family history of stroke may reflect complex behavioral responses to prior stroke experience in the family