Timely thrombolysis after acute ischemic stroke (AIS) requires arrival within the window period. Substantial delay happens in presentation to the hospital which prevents optimal treatment.

We looked into the prevalence and the reasons for pre-hospital delay after AIS in our hospital in Western Tamil Nadu.

Consecutive cases of AIS visiting our hospital from April 2018 to March 2019 were included in the study. A structured questionnaire was used to collect data regarding demographic details, presenting symptoms, time of stroke onset and arrival, mode of transport and knowledge about stroke and thrombolysis.

Overall 505 patients were enrolled. The mean age was 60.76±13.71 years. 352 patients came outside the window period giving a prevalence of 69.7%. Factors associated with late arrival were longer distance, rural living and lack of education (p=0.000). Visits to nearby clinic before reaching our centre resulted in significant delay (p=0.000). Patients who had ambulance access came early (p=0.000).Knowledge about stroke and window period facilitated early arrival (p=0.000). Interestingly, 25% (88/352) of patients who came out of window period to our hospital had visited nearby clinics within the window period before getting referred to our hospital. Facial deviation, speech disturbances, headache and ataxia at presentation had a positive correlation whereas vertigo and seizures had a negative correlation with early arrival.

Around 70% of our patient population with AIS arrive late for thrombolyis. Staying away in rural areas, lack of education and awareness about stroke and thrombolysis, lack of access to ambulance services account for the pre-hospital delay. Presence of vertigo and seizures at stroke onset are distractors. A sizeable number of patients are unlucky since they are not thrombolysed despite reaching within the window period to the nearby clinics. Empowerment of community physicians to thrombolyse before transfer of patients to higher centres may allow more patients to receive thrombolysis.