Pre-hospitalar Factors Associated with Delayed Arrival of Stroke Patients in Emergency Room in Brazil

Background: Late hospital presentation after acute stroke is one of the main reasons for low rates of intravenous thrombolysis. This study aimed to investigate the factors associated with presentation delays after an acute stroke. Methods: A cross-sectional study with consecutive stroke patients from a Brazilian public university Stroke Center assisted from May 2018 to August 2019. Patients were interviewed from a structured questionnaire involving sociodemographic data, clinical history, the context in which the stroke occurred and knowledge about the disease. Results: Of the 154 patients interviewed, 78% had ischemic stroke and 14% hemorrhagic stroke. The mean age was 64.414, 53% were men and 43% patients arrived before 4.5h. Knowledge about the therapeutic window was low (59% of all patients). Decreased level of consciousness, concomitant psychiatric disease, transferred patients and not seeking immediate medical help were associated with late arrival. In multivariate analysis, males (OR 2.27,95%CI, 1.06-4.90) did not seek immediate medical help (OR 9.44, 95%CI 4.0-22.0) and transferred patients (OR 3.61, 95%CI, 1.64-7.92) were associated with arrival after 4.5h. Conclusions: Despite concerted efforts to raise public awareness, substantial delays in seeking care after a stroke persist within this population. Future initiatives should focus on comprehensive educational programs targeting both the general population and healthcare professionals across all levels of care to address and mitigate these delays.