SynthesisInternational journal of stroke : official journal of the International Stroke Society2009
A comprehensive review of prehospital and in-hospital delay times in acute stroke care.
Synthesis in International journal of stroke : official journal of the International Stroke Society, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 115 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
115 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Prehospital delay and associated factors among stroke patients in Africa: A systematic review and meta-analysis.PloS one · 2025Pooled it
- Effectiveness of interventions to improve rates of intravenous thrombolysis using behaviour change wheel functions: a systematic review and meta-analysis.Implementation science : IS · 2020Pooled it
- Stroke Warning Information and Faster Treatment (SWIFT): Cost-Effectiveness of a Stroke Preparedness Intervention.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2019Trial
- Effect of a comprehensive health education program on pre-hospital delay intentions in high-risk stroke population and caregivers.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2017Trial
- Why Patients Delay Their First Contact with Health Services After Stroke? A Qualitative Focus Group-Based Study.PloS one · 2016Trial
- Effect of Prehospital Time on Door-to-Computed Tomography Time in Acute Ischemic Stroke: A Multicenter Study.Brain and behavior · 2026Observational
- Clinical symptoms associated with prehospital delay in first-ever acute stroke.Biomolecules & biomedicine · 2026Observational
- Rural Computed Tomography - a model for access to rapid stroke care in sparsely populated areas?BMC health services research · 2026Article
- COVID-Related Discrimination and Health Care Access among a Nationally Representative, Diverse Sample of US Adults.Journal of racial and ethnic health disparities · 2026Article
- External validation of machine learning models for predicting prehospital delay in acute ischemic stroke: a retrospective cohort study.Frontiers in neurology · 2026Article
- Recent research progress and future directions of intracerebral hemorrhage.Frontiers in immunology · 2026Review
- Review
- Analysis of prehospital delay in acute ischaemic stroke and its influencing factors: a multicentre prospective case registry study in China.Stroke and vascular neurology · 2025Article
- Factors facilitating pre-hospital delays in stroke patients' presentation to hospital by their caretakers in Uganda and suggested interventions.BMC neurology · 2025Article
- Factors associated with late hospital arrival in acute stroke patients of Bangladesh.Emergency medicine journal : EMJ · 2025Article
- A Novel Artificial Intelligence-Enhanced Digital Network for Prehospital Emergency Support: Community Intervention Study.Journal of medical Internet research · 2025Article
- Effect of working hours on prognosis of acute ischemic stroke patients following alteplase intravenous thrombolysis.The Journal of international medical research · 2024Article
- Analysis of onset-to-door time and its influencing factors in Chinese patients with acute ischemic stroke during the 2020 COVID-19 epidemic: a preliminary, prospective, multicenter study.BMC health services research · 2024Article
- Quality Indicators and Clinical Outcomes of Acute Stroke: Results from a Prospective Multicenter Registry in Greece (SUN4P).Journal of clinical medicine · 2024Article
- Burden of serious harms from diagnostic error in the USA.BMJ quality & safety · 2024Article
55 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
The purpose of this study was to systematically review and summarize prehospital and in-hospital stroke evaluation and treatment delay times. We identified 123 unique peer-reviewed studies published from 1981 to 2007 of prehospital and in-hospital delay time for evaluation and treatment of patients with stroke, transient ischemic attack, or stroke-like symptoms. Based on studies of 65 different population groups, the weighted Poisson regression indicated a 6.0% annual decline (P<0.001) in hours/year for prehospital delay, defined from symptom onset to emergency department arrival. For in-hospital delay, the weighted Poisson regression models indicated no meaningful changes in delay time from emergency department arrival to emergency department evaluation (3.1%, P=0.49 based on 12 population groups). There was a 10.2% annual decline in hours/year from emergency department arrival to neurology evaluation or notification (P=0.23 based on 16 population groups) and a 10.7% annual decline in hours/year for delay time from emergency department arrival to initiation of computed tomography (P=0.11 based on 23 population groups). Only one study reported on times from arrival to computed tomography scan interpretation, two studies on arrival to drug administration, and no studies on arrival to transfer to an in-patient setting, precluding generalizations. Prehospital delay continues to contribute the largest proportion of delay time. The next decade provides opportunities to establish more effective community-based interventions worldwide. It will be crucial to have effective stroke surveillance systems in place to better understand and improve both prehospital and in-hospital delays for acute stroke care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.