Abstract Number: Esoc2026a787 Time-to-Treatment Metrics in the Philippines’ First Local Government Unit-Anchored Telestroke Network: A Retrospective Analysis of Onset-to-Door Delays in an Urban Low- And Middle-Income Country Setting

Abstract Background and aims Prehospital delay is the most common barrier to reperfusion therapy in acute ischemic stroke, particularly in low- and middle-income countries (LMICs). Although telestroke networks can expand access to specialist decision-making, their effectiveness remains constrained by late hospital arrival. Data describing onset-to-door time metrics in LMIC telestroke systems are limited. This study aimed to characterize onset-to-door delays, thrombolysis-window arrival, and geographic variation within an urban, government-anchored telestroke network. Methods We conducted a retrospective cohort study of all stroke referrals recorded in an urban telestroke network from program inception through December 2025. Routinely collected data included ictus time, door time, barangay of origin, demographics, diagnosis, and thrombolysis status. Onset-to-door time (minutes) was calculated for referrals with complete timestamps. Primary outcomes were median onset-to-door time and proportion arriving within the thrombolysis window (≤4.5 hours). Sensitivity analyses excluded records requiring midnight time correction and extreme delays (12 hours). Results Among 57 telestroke referrals, 50 (87.7%) had complete ictus and door timestamps and were included in the primary analysis. Median onset-to-door time was 101.5 minutes (IQR 61.0–212.5). Overall, 86.0% arrived within 4.5 hours. Marked barangay-level variation was observed, with median delays ranging from under 90 minutes to over 400 minutes. Sensitivity analyses excluding midnight-adjusted cases and extreme delays yielded similar results. Conclusions In this urban LMIC telestroke network, most patients arrived within the thrombolysis window, although substantial geographic disparities persist. Onset-to-door time is a robust and actionable system-performance metric for guiding targeted interventions to improve access to time-dependent stroke care. Conflict of interest Gerard Vincent Aguas: Nothing to disclose Figure 1 - belongs to Results