| dc.description.abstract | Background. Timely hospital arrival is a pivotal determinant of successful reperfusion therapy and neurological outcomes in stroke care. Behavioral and systemic barriers, such as limited symptom awareness, inadequate transport access, and extended travel distance, often contribute to prehospital delay. Objective. To identify key determinants of delayed hospital arrival among stroke patients, emphasizing the roles of stroke symptom awareness, clinical severity (NIHSS), and mode of transportation. Methods. A cross-sectional analytical study was conducted among 140 stroke patients admitted to Adam Malik General Hospital and Prof. Dr. Chairuddin P. Lubis Universitas Sumatera Utara Hospital, Universitas Sumatera Utara, Medan, 20155. Independent variables included age, gender, awareness of stroke, awareness of stroke symptoms, awareness of stroke risk factors, NIHSS score, distance to hospital, transportation mode, and educational level. Bivariate analysis employed chi-square tests, followed by multivariate binary logistic regression. Results. A total of 72.1% of patients arrived more than 4.5 hours after symptom onset. Significant predictors of delayed arrival were age (p = 0.011), symptom awareness (p < 0.001), risk factor awareness (p < 0.001), NIHSS (p < 0.001), transportation mode (p = 0.048), education (p = 0.037), and hospital distance (p = 0.044). Multivariate analysis revealed that good symptom awareness increased the likelihood of early arrival by 5.7-fold (OR = 5.741; p = 0.003), whereas higher NIHSS scores doubled the risk of delay (OR = 2.473; p < 0.001). Compared with private vehicles, ambulance use reduced the likelihood of delay by 77% (OR = 0.228; p = 0.015), while online transport not significant. Conclusion. Stroke symptom awareness, stroke severity, and transportation mode are the strongest determinants of timely hospital arrival. Enhancing community-level stroke education and optimizing emergency transport systems could substantially reduce prehospital delays and improve clinical outcomes. | en_US |
