LATE PRESENTATION OF STROKE PATIENTS TO TERTIARY CARE HOSPITALS THE UNDERLYING REASONS

Abstract

Background: Stroke is a major neurological emergency and a leading cause of morbidity and mortality worldwide. Timely hospital presentation is crucial for effective treatment, including intravenous thrombolysis and endovascular therapy, both of which significantly improve outcomes. However, delays in hospital presentation remain prevalent, especially in resource-limited settings, due to socioeconomic, logistical, and awareness-related factors. Understanding these barriers is essential for implementing effective interventions to reduce prehospital delays and improve stroke care outcomes.

Objective: To evaluate the awareness and knowledge of stroke patients and their companions presenting to a tertiary care hospital and to identify the common causes of prehospital delays.

Methods: This cross-sectional retrospective study was conducted at Sheikh Zayed Hospital, Lahore, over six months, including 200 patients with ischemic or hemorrhagic stroke who met the inclusion criteria. Data were collected on variables such as age, sex, time since last known well (LKW), education level, knowledge of stroke symptoms, availability of transportation, lifestyle (urban or rural), and history of prior treatment. Patients younger than 18 or with non-stroke neurological conditions were excluded. Data were analyzed using SPSS version 25, with descriptive and inferential statistics calculated. The Chi-square test was applied to identify statistically significant associations.

Results: The mean age of participants was 60.1 ± 18.5 years, with ischemic stroke comprising 76% (n = 152) of cases and hemorrhagic stroke 24% (n = 48). Among the cohort, 55% (n = 110) presented early (within 4 hours), while 45% (n = 90) presented late. A total of 70% (n = 140) of patients did not recognize stroke symptoms, and 75.3% (n = 151) reported lack of transportation as a barrier. Distance from the hospital affected 40.1% (n = 80) of rural patients, requiring over 45 minutes of travel. A statistically significant association was found between stroke knowledge and timing of hospital presentation (p = 0.013).

Conclusion: A considerable proportion of stroke patients presented late to the hospital due to factors such as low literacy, reliance on public transportation, misinterpretation of symptoms, and low perceived severity of their condition. Addressing these barriers through targeted educational programs and systemic healthcare improvements is critical for enhancing timely access to stroke care.