Factors Associated with Prehospital Delay in Acute Stroke

Background

Timely arrival at a stroke-capable facility is critical for access to reperfusion therapies, yet prehospital delay remains a major barrier to effective acute stroke care, particularly in low- and middle-income settings. This project synthesises the published evidence on the factors associated with delay in reaching care after stroke onset. Understanding these determinants is essential for designing interventions to shorten the time from symptom onset to treatment.

Approach

The defensible core of the work is a systematic review of factors associated with prehospital delay conducted per PRISMA guidance, developed from mid-2025 with collaborators Dr. Anand Neelakantan and Dr. Srividhya Anand and supported by a curated reference library. A related, separate strand is a geographic accessibility analysis in R, mapping stroke centres and using geocoding and drive-time/distance estimation to characterise spatial access to acute stroke care; this is an access-focused analysis rather than a patient-level reanalysis of delay determinants.

What we found

• The systematic review synthesises the factors associated with prehospital delay in acute stroke; detailed results will be reported on publication.
• A complementary geographic analysis examines access to stroke-capable centres and treatment-window coverage.

Outputs & impact

By synthesising the evidence on prehospital delay and complementing it with a geographic analysis of stroke-centre access, the project aims to inform interventions that reduce delay and improve access to time-sensitive stroke care. The systematic review manuscript has been submitted to an Indian public-health journal (submission late 2025).