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. 2025 Aug 13;25(1):340.
doi: 10.1186/s12883-025-04361-8.

Study on delay factors and time to hospital arrival after acute stroke in patients at Shahid Rajaei hospital, Tonekabon (2022-2023)

Mohadeseh Farokhfar  1 , Mohamad Saleh Pezeshki Almani  2
Affiliations

Study on delay factors and time to hospital arrival after acute stroke in patients at Shahid Rajaei hospital, Tonekabon (2022-2023)

Mohadeseh Farokhfar et al. BMC Neurol. .

Abstract

Background: Stroke is a sudden focal neurological deficit caused by vascular damage to the central nervous system. Globally, stroke is a leading cause of death and disability, with a particularly significant burden in low- and middle-income countries. In Iran, the incidence of acute stroke is increasing, and the age of onset is lower compared to developed countries. This study examines factors causing pre-hospital delays in acute stroke patients at Shahid Rajaei Hospital, Tonekabon, North of Iran (2022-2023). Timely intervention is critical for improving outcomes, as delays significantly affect treatment effectiveness. This study aims to identify the primary causes of pre-hospital delays in acute stroke patients and provide actionable insights to enhance timely intervention strategies, ultimately improving patient outcomes.

Methods: A retrospective descriptive-analytical study was conducted on 150 acute stroke patients using census sampling. Data included demographics, symptoms, and time intervals from onset to hospital arrival. Analysis was performed with SPSS using chi-square, T-tests, and ANOVA.

Results: Of the 150 patients, 81.3% arrived over 4.5 hours after symptom onset, missing the thrombolytic treatment window. Statistical analysis revealed significant associations between some demographic and clinical factors: shorter distances to the hospital and faster arrival (p = 0.037), presence of a witness (p = 0.041), and stroke onset during the daytime (p = 0.002) were linked to reduced delays. Marital status also influenced arrival times significantly (p = 0.007). Other delay factors included unawareness of stroke symptoms (46%), being alone (14.7%), and symptoms occurring during sleep (8.6%).

Conclusions: The study highlights the need for public education on stroke symptoms and improved emergency systems to reduce delays. Addressing these gaps can enhance patient outcomes, especially in areas with limited awareness and resources.

Keywords: Health education; Stroke; Thrombolytic therapy; Time-to Treatment.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The present study has been approved by Ethics committee of Mazandaran University of Medical Sciences in Ramsar Campus (IR.MAZUMS.RIB.REC.1401.091).and certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. As part of hospital protocol, an informed consent form is routinely added to the medical file of all patients upon admission at Shahid Rajaee Hospital. This document outlines the patient’s voluntary cooperation with clinical evaluations and permits the ethical use of medical data in future scientific research. In this study, only the records of patients who signed the written consent form (attached) were included. In addition, each patient or their legal guardian was individually contacted, and the objectives of the study were thoroughly explained. Following these discussions, verbal consent was obtained once again. Patients who, after full clarification, declined participation for any reason were not enrolled in the study. Consent for publication: All participants and their witnesses were verbally informed about the nature and purpose of the study, including the potential publication of anonymized clinical and demographic data. Participation was voluntary, and individuals who provided oral consent were enrolled in the study. In addition, upon admission, all patients or their legal representatives signed a written consent form acknowledging that Shahid Rajaei Hospital is a teaching and research-oriented medical center. The consent form clarified that information from medical records may be used for research purposes and academic publication, without compromising confidentiality. Only records with signed consent forms (attached) were reviewed and included in this analysis. Competing interests: The authors declare no competing interests.

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