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Prehospital delay in acute stroke and TIA
  1. Kashif Waqar Faiz1,2,
  2. Antje Sundseth1,2,
  3. Bente Thommessen2,
  4. Ole Morten Rønning1,2
  1. 1Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  2. 2Department of Neurology, Akershus University Hospital, Lørenskog, Norway
  1. Correspondence to Dr Kashif Waqar Faiz, Akershus University Hospital, Department of Neurology, N-1478 Lørenskog, Norway; kashif.faiz{at}


Background Early management improves outcome in acute stroke. This study was designed to assess the prehospital path from symptom onset to arrival in hospital and to identify factors associated with prehospital delay.

Methods A prospective study was conducted including patients with acute ischaemic stroke, intracerebral haemorrhage and transient ischaemic attack admitted to hospital. Time intervals for prehospital delay, background data, severity, type of first medical contact and mode of transport were recorded. Univariate and multivariate analyses were performed to identify factors influencing prehospital delay.

Results A total of 440 patients were included, with a mean age of 71.4±13.0 years (44.3% female subjects), consisting of 65.9% patients with ischaemic stroke, 11.4% with intracerebral haemorrhage and 22.7% with transient ischaemic attack. The median time from symptom onset to admission was 3.0 h (179 min; IQR 77–542). The median decision delay was 1.5 h (92 min, IQR 25–405) and accounted for 55.1% (median value) of the prehospital delay. 310 (70.5%) patients arrived by ambulance. In the multivariate linear regression analysis, high National Institute of Health Stroke Scale score (p<0.001), transport by ambulance (p<0.001) and lower age (p=0.048) were significantly associated with early admission.

Conclusions Severe strokes, use of ambulance and lower age are associated with reduced prehospital delay. The present study shows that more than half of the delay is caused by the hesitation to contact medical services. Public information campaigns should focus on fast symptom recognition and the importance of immediately contacting the Emergency Medical Services upon symptom onset.

  • Stroke
  • emergency medical services
  • thrombolytic therapy
  • neurology
  • prehospital care
  • communications
  • acute medicine-other
  • epilspsy
  • guidelines
  • peripheral

Statistics from


  • Funding The principle investigator (KWF) was funded by the University of Oslo.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the Regional Committee for Ethics in Medical Research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available on request from the corresponding author.

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