Abstract

Timely presentation to the emergency department (ED) is critical for ischemic stroke patients to receive thrombolysis within the recommended 4.5-hour window. Socioeconomic and demographic factors, including age, race, income level, and living situation, may influence delays in arrival, potentially limiting access to time-sensitive interventions. This study identifies predictors of delayed arrival beyond 4.5 hours from the last known normal (LNK) and evaluates disparities in stroke care access.

Methods:

This retrospective cohort study analyzed ischemic stroke patients treated at a comprehensive stroke center between 2023-2024. Patients were stratified based on whether they arrived within or beyond the 4.5-hour window. Predictor variables included age, race, income, living alone status, and mode of transportation. A multivariable logistic regression model was performed to assess independent predictors of delayed presentation while controlling for distance to the hospital. A subgroup analysis was conducted among patients living within a defined radius from the hospital to isolate socioeconomic influences from geographic constraints.

Preliminary Results:

Delayed Presentation: 39 (21.2%) of patients arrived beyond 4.5 hours from LNK.

Demographic Predictors: Older age and African American race were associated with a higher likelihood of delayed arrival.

Socioeconomic Predictors: Patients from low SES backgrounds (uninsured or Medicaid) and those living alone were less likely to arrive within the thrombolysis window.

Mode of Transportation: Patients using private transport were significantly more likely to present late compared to those using EMS.

Geographic Influence: Among patients residing within a defined hospital radius, SES disparities remained significant predictors of delayed presentation, independent of distance.

Conclusion:

Demographic and socioeconomic factors strongly predict delayed stroke presentation, limiting timely access to thrombolysis. Targeted public health initiatives, enhanced community stroke awareness, and improved EMS accessibility in high-risk populations may mitigate these delays and improve outcomes.