Factors Delaying Admission to a Hospital-based Stroke Unit in India

Limited information is available from India and other developing countries regarding the various factors that contribute to a delay in hospital admission after stroke. The stroke unit of the Christian Medical College, Ludhiana, in Northwest India prospectively studied the various factors contributing to delay in hospital admission during a 15-month period ending September 2003. Patients or their relatives were interviewed within 48 hours of admission using a structured questionnaire. Of the 147 patients interviewed, 99 (67%) were men and the mean age was 59.7 ± 14.1 years. A total of 43 (29%) patients presented within 3 hours of stroke onset. Only 12% of patients came by ambulance. Directly reaching the stroke department (P < .001, odds ratio [OR] 4.2, confidence interval [CI] 3.13-8.45), distance 10 km or less from the hospital (P < .03, OR 4.0, CI 1.12-9.24), and presence of aphasia (P < .03, OR 3.7, CI 1.47-7.92) were the factors associated with an early arrival. We found a considerable delay in the early arrival of patients to our stroke department. Both local physicians and the public should be educated about the importance of an early referrals and presentation to the stroke centers.