Factors Affecting Prehospital Delay in Patients with Acute Ischemic Stroke in the Republic of Georgia: A Countrywide, Prospective Study

INTRODUCTION: Recently, a nationwide stroke care consisting of stroke care units (SCUs) and stroke centers (SCs) was established in the Republic of Georgia. PATIENTS AND METHODS: A hospital-based prospective registry to evaluate the quality of stroke care and an additional nationwide survey on factors leading to prehospital delay and subsequent low rate of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT). RESULTS: A total of 5,385 consecutive patients with acute stroke (3,636 ischemic, 1,302 TIA, and 447 hemorrhagic) were included in the stroke registry, of whom 2,459 (46%) were female, with a mean age of 70.3±11.3 years. A total of 1,538 (28.6%) patients presented <6 h (1,160 [21.5%] <4.5 h). Of 3,636 patients with ischemic stroke, 121 (3.3%) patients received IVT, 72 (2.0%) received EVT, and 17 (0.5%) received both. An additional 1,067 patients with acute ischemic stroke (898) and TIA (169) were interviewed to understand the factors of prehospital delay. Of these, 472 (44.2%) were female, with a mean age of 70.5 ± 11.4 years, and 339 (31.8%) patients arrived <6 h (219 [20.5%] <4.5 h). Forty-two patients (4.7%) received IVT, 37 (4.1%) received EVT, and 6 (0.7%) received both. Pre-ictal education level, high socio-economic status, stroke awareness, calling the ambulance, and a knowledgeable ambulance team transferring patients to the stroke-ready hospital predicted timely arrival at the SC. CONCLUSIONS: The study reveals major problems in the prehospital management of acute stroke. DISCUSSION: There is a great need for a nationwide geographic transfer plan for acute stroke service, connecting ambulances, SCUs, and SCs and for the educational campaigns to increase stroke awareness among the population.