Factors Associated With Prehospital Delay in Acute Ischemic Stroke: A Comparative Study of First-Time and Recurrent Cases

Abstract

Background:

Prehospital delay, defined as prehospital time (from symptom onset to hospital arrival) ≥3 hours, adversely affects outcomes in patients with acute ischemic stroke. It is prevalent both among patients with first-time and recurrent stroke, who differ in disease and psychological characteristics affecting their health-seeking behavior. However, comparative studies on delay-related factors between these groups are limited.

Objectives:

We aimed to identify and compare factors influencing prehospital delay among patients with first-time and recurrent acute ischemic stroke.

Methods:

This 2-center, hospital-based, cross-sectional study enrolled 144 first-time and 142 recurrent patients with acute ischemic stroke in Guangzhou, China. Patients’ prehospital times were recorded. Standardized questionnaires were used to assess stroke knowledge, family function, and stigma. Data were analyzed using univariate analysis and multiple logistic regression.

Results:

Emergency medical services utilization reduced prehospital delay in both groups (first-time: odds ratio [OR] = 0.173, 95% CI: 0.040-0.750; recurrent: OR = 0.100, 95% CI: 0.022-0.466). Poor family function increased the risk of delay (first-time: OR = 1.057, 95% CI: 1.003-1.113; recurrent: OR = 1.131, 95% CI: 1.039-1.230). Among patients with recurrent stroke, greater stroke knowledge was protective (OR = 0.983, 95% CI: 0.968-0.999), while higher stigma increased delay (OR = 1.053, 95% CI: 1.012-1.095).

Conclusions:

Emergency medical services utilization and strong family function reduce prehospital delay in both patients with first-time and recurrent stroke, while increased stroke knowledge and reduced stigma specifically benefit patients with recurrent stroke. Targeted strategies addressing these factors are recommended.