Background: Delayed hospital arrival lowers the proportion of patients with stroke receiving recanalization therapy and results in poor outcomes. This study investigated the factors associated with pre-hospital delays in hospital arrival after stroke onset in the Thanh Hoa Province, Vietnam. Methods: Clinical data were collected from stroke patients within 7 days of symptom onset who were prospectively registered in this study. Patients and/or their relatives were interviewed using a structured questionnaire about patient social demographics, address, post-stroke support actions, and stroke awareness. Pre-hospital delay in hospital arrival was dichotomized into <4.5 hours and > 4.5 hours, and multivariable logistic regression analysis was used to investigate factors associated with the delay. Result: Of the 328 participants analyzed, 181 (55.4%) arrived at the hospital 4.5 hours after the symptom onset. The patients' and relatives' awareness of stroke was poor. Pre-hospital delays were longer for patients living > 10 km away from a healthcare facility and those with secondary or lower education levels, with odds ratios of 2.07 and 1.98, respectively. Seeking care at a district or private hospital as the first point of healthcare or non-use of emergency medical services did not show significant associations. Discussion: The study revealed that most patients with stroke did not arrive at the hospital in time for recanalization therapy. Moreover, the low stroke awareness among patients and their relatives is concerning. Further research is needed to investigate the reasons for pre-hospital delays and develop targeted interventions to improve stroke awareness and reduce these delays.

The authors have declared no competing interest.

This work was supported by the Japan Society for the Promotion of Science KAKENHI (19K09403); the funding body did not play any role in conducting the study or preparing the manuscript.

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this study was approved by the ethics committees of Thanh Hoa General Hospital and School of Health Innovation, Kanagawa University of Human Services

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