Time Lost Is Brain Lost: Insights into Acute Ischaemic Stroke Delays in a Tertiary Care Super-speciality Centre in Jharkhand

Background Early hospital arrival is essential for timely thrombolysis in acute ischaemic stroke. However, many patients in low-resource settings continue to reach tertiary care centres beyond the recommended treatment window. Purpose To evaluate pre-hospital and in-hospital delays among patients with acute ischaemic stroke in Jharkhand and identify factors associated with timely hospital arrival. Methods A prospective observational study included 237 consecutive patients with acute ischaemic stroke admitted to a tertiary care hospital in Ranchi (July 2022–August 2024). Patients were classified as early (≤4.5 h) or delayed (>4.5 h), and multivariable logistic regression identified predictors of early hospital arrival. Results Only 15 patients (6.3%) reached the hospital within 4.5 h. Most were men, older adults and from rural, socio-economically disadvantaged backgrounds. Most (85.7%) first visited a nearby non-specialist healthcare facility, while awareness of stroke symptoms (14.0%) and thrombolysis (5.5%) was poor. Timely arrival was less likely after visiting a nearby healthcare facility (aOR 0.005, p < .001) but more likely with higher socio-economic status (aOR 17.02, p = .016) and ambulance availability (aOR 6.11, p = .021). Conclusion Improving ambulance services, referral pathways and public awareness may reduce delays and improve timely stroke treatment.