Reasons for Delayed Thrombolysis in Low-resource Emergency Departments: A Qualitative Study of Stroke Patients and Witnesses

Abstract

Introduction

Stroke remains a leading cause of death and disability worldwide, with a high burden in low-resource settings like Nepal. Timely administration of intravenous thrombolysis is critical for improving outcomes in patients with acute ischemic stroke. However, delays in receiving thrombolysis can significantly reduce its effectiveness and impact recovery. This study aimed to explore and understand the reasons contributing to delays in thrombolysis among stroke patients in emergency departments within low-resource settings through a qualitative approach.

Methods

A qualitative study was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Eighteen participants, including ten stroke patients and eight witnesses, were interviewed using a semi-structured guide. Data were analyzed using thematic analysis to identify common themes regarding treatment delays.

Results

The study identified four primary reasons contributing to delays in thrombolysis treatment: (a) failure of patients and witnesses to recognize stroke symptoms early, (b) limited availability of thrombolysis services in the hospitals, (c) financial barriers to seeking care, and (d) delayed diagnosis or misdiagnosis by healthcare professionals.

Conclusion

This study highlights the significant barriers to thrombolysis delays in Nepal. Key interventions, such as improving public awareness of stroke symptoms, increasing access to thrombolysis services, and reducing financial barriers, are necessary to improve outcomes in stroke patients.