To identify causes of in-hospital delays in the treatment of acute ischaemic stroke at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana.

Management of acute ischemic stroke is time dependent. Most developing countries face both out-of-hospital and in-hospital delays in stroke care, even in hospitals like KBTH where intravenous tPA is available.

This was a prospective cohort study of adults with ischemic stroke admitted to the KBTH stroke unit from November 2020 to June 2022.  We used structured questionnaires to identify factors related to in-hospital care delays.  NIH Stroke Scale (NIHSS) on all participants at admission and a phone-based modified Rankin Scale (mRS) 30 days after symptom onset.  Participants were dichotomized into early (<4.5 hours) and late (>4.5 hours) presenters based on the time of presentation to the hospital after symptom onset.

Of 114 participants, average age was 62.6 ±13.4, 42.1% were male, and the average admission NIHSS for early and late presenters was 13.4 and 11.0, respectively(P=0.185). Most participants (70%) arrived at the hospital within 4.5 hours of symptom onset. However, only 1.3% received tPA. Median time from arrival at the emergency department to the doctor’s initial evaluation, CT scan completion, CT scan interpretation, and treatment initiation were 1.0 hours, 6.5 hours, 16.9 hours, and 9.8 hours, respectively. In-hospital delays were mostly due to late requests for CT scan (35%), and delays in transporting patients to the CT scan area. Average mRS at 30 days was 3.2 for early presenters and 2.5 for late presenters (p=0.032), but no differences in in-hospital outcomes were observed.

Stroke education campaigns and the availability of tPA are not sufficient to ensure patients are receiving the best evidence-based acute stroke care available.  Health systems interventions are urgently needed to improve delivery of time-sensitive acute stroke interventions.