PT - JOURNAL ARTICLE AU - Su, Ying AU - Qi, Wenwei AU - Yu, Yanni AU - Zhu, Jiaqian AU - Shi, Xin AU - Wu, Xiaohong AU - Chi, Feng AU - Xia, Runyu AU - Qin, Limin AU - Cao, Liming AU - Yang, Yan AU - Liu, Qin AU - Peng, Xiaoxiang AU - Huang, Guobing AU - Chen, Jinyan AU - Xue, Yidong AU - Guan, Wenbiao AU - Gao, Dan AU - Ye, Bin AU - Ren, Lijie TI - Analysis of prehospital delay in acute ischaemic stroke and its influencing factors: a multicentre prospective case registry study in China AID - 10.1136/svn-2024-003535 DP - 2025 Mar 04 TA - Stroke and Vascular Neurology PG - svn-2024-003535 4099 - http://svn.bmj.com/content/early/2025/03/14/svn-2024-003535.short 4100 - http://svn.bmj.com/content/early/2025/03/14/svn-2024-003535.full AB - Background Prehospital delay in acute ischaemic stroke (AIS) remains prevalent in China. We aimed to assess the status of the onset-to-door time (ODT) in AIS and analyse its influencing factors.Methods Data were collected from a prospective multicentre hospital-based registry (China National Cerebrovascular Disease Prevention and Control Project Management Special Database) of patients with AIS involving 21 hospitals across different economic and geographical regions in China in 2022. The Mann-Whitney U test or t-test was used for between-group comparisons. Factors influencing ODT ≤3 hours were analysed using a binary logistic regression model.Results Of the included 12 484 patients (attended middle school or below, 69.2%), females had a higher illiteracy rate (13.1%) than males (4.8%); 94.8% were living with others at illness onset; 22.5% of patients/family members were aware of the stroke emergency map (SEM, but only 7.3% were transported by SEM; 76.8% lived within 20 km of the first visited hospital. Significant differences occurred in modes of arrival at hospitals among cities of different sizes (χ²=74.882, p<0.001). Being in a medium-sized (OR 0.65, 95% CI 0.50 to 0.86); large (OR 0.61, 95% CI 0.47 to 0.79) or extralarge city (OR 0.60, 95% CI 0.46 to 0.78); experiencing cardiogenic embolism (OR 0.65, 95% CI 0.50 to 0.86) or stroke of undetermined aetiology (OR 0.69, 95% CI 0.52 to 0.92); stroke onset between 18:00 and 23:59 (OR 0.71, 95% CI 0.60 to 0.85); distance <20 km from onset location to the hospital (OR 0.47, 95% CI 0.41 to 0.54); being transported by SEM (OR 0.31, 95% CI 0.26 to 0.36) and having initial National Institutes of Health Stroke Scale scores of 5–15 (OR 0.63, 95% CI 0.57 to 0.71) or 16–42 (OR 0.32, 95% CI 0.27 to 0.39) were independent factors favouring ODT ≤3 hours. Conversely, being transferred between hospitals during transportation (OR 3.31, 95% CI 2.66 to 4.14); experiencing wake-up stroke (OR 2.00, 95% CI 1.67 to 2.38); symptom-onset including dizziness (OR 1.28, 95% CI 1.10 to 1.47) and prestroke modified Rankin scale (mRS) score of 2–3 (OR 1.58, 95% CI 1.30 to 1.92) or 4–5 (OR 1.48, 95% CI 1.02 to 2.15) tended to indicate ODT >3 hours.Conclusions Urban scale, stroke type, onset time, distance from initial location to the first hospital visit, transportation method, stroke symptoms, prestroke mRS score and stroke severity significantly influenced prehospital delay. Our findings can facilitate the development of targeted policies.Data are available on reasonable request.