Abstract:
Background: Ischemic strokes make up the majority of stroke cases globally and regionally, with significant mortality. Timely hospital arrival is critical for improving outcomes.
Objectives: To assess the impact of onset-to-door time on neurological improvement and identify factors contributing to delayed hospital arrival among acute ischemic stroke patients at Axon Stroke and Spine Center.
Methods: A retrospective cohort study was conducted from October 1, 2022, to January 30, 2025. Patient records were selected via simple random sampling. Onset-to-door time was categorized as early (<4.5 hours) or delayed (>4.5 hours). Neurological improvement was evaluated using NIHSS scores at admission and discharge. Logistic regression was used to identify associated factors.
Result: Delayed arrival occurred in 78% (95% CI: 74–82%) of patients. Neurological improvement was observed in 41% (95% CI: 35–46%). Delayed arrival was significantly associated with age 60–69 years (AOR = 2.77), age 70–79 years (AOR = 2.31), and no prior stroke history despite being on follow-up (AOR = 2.19). Neurological improvement was more likely in patients with early arrival (AOR = 1.84), GCS 13–15 at admission (AOR = 3.95), and those who developed urinary tract infections during hospitalization (AOR = 0.41).
Conclusion and recommendation: Older age and lack of prior stroke history are associated with delayed hospital presentation, while early arrival and better consciousness at admission predict neurological improvement. Prospective studies using direct interviews are recommended, and referral systems should be strengthened.
Key words: onset-to-door time, neurological improvement, delayed hospital arrival, acute ischemic stroke