ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1669361
This article is part of the Research TopicBridging The Gap of Unmet Need in Stroke Care in Developing CountriesView all 15 articles
Stroke knowledge and attitudes influence early hospital arrival in acute ischemic stroke: a multicenter cross-sectional survey from Hubei Province, China
Provisionally accepted
- Huanggang Central Hospital, Huanggang, China
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Background: Prehospital delay remains a major challenge in China and is a critical barrier to timely intravenous thrombolysis in patients with acute ischemic stroke (AIS). However, the contributing factors—particularly the roles of stroke knowledge and attitudes—are not yet fully understood. This study aimed to examine the associations between stroke knowledge, attitudes, and other potential covariates with prehospital delay. Methods: We conducted a multicenter, cross-sectional study between June and December 2023 across fifteen certified stroke centers affiliated with general hospitals in Hubei Province, China. Data on sociodemographic characteristics, stroke knowledge and attitudes were collected using a structured, self-administered questionnaire. Multiple logistic regression analyses were performed to identify factors associated with prehospital delay. Results: A total of 1,870 AIS patients were included; 428 (22.9%) arrived within 3 hours, and 704 (37.6%) within 6 hours of symptom onset. Median prehospital delay was 11.0 hours (IQR: 4.0–30.0). Multivariate logistic regression analysis revealed that higher stroke knowledge scores (adjusted OR, 1.15; 95% CI, 1.09–1.21) and higher stroke attitude scores (adjusted OR, 1.26; 95% CI, 1.18–1.33) were significantly associated with earlier arrival. Additional predictors included experiencing stroke onset at a location within 20 km of the hospital (adjusted OR, 2.50; 95% CI, 1.87–3.34), sudden progression of symptoms (adjusted OR, 2.64; 95% CI, 2.05–3.39), NIHSS score ≥6 at admission (adjusted OR, 1.34; 95% CI, 1.02–1.75), and arrival by ambulance (adjusted OR, 1.99; 95% CI, 1.48– 2.68). Similar associations were observed for the 6-hour threshold. Conclusion: Our findings highlight that greater stroke knowledge and positive attitudes significantly influence early hospital arrival in AIS patients. Sudden symptom onset, ambulance use, and shorter transfer distances also facilitate timely hospital arrival, whereas mild stroke contribute to delays. Thus, future stroke interventions should take these characteristics into account, which might ultimately help to promote earlier hospital arrival.
Keywords: Acute ischemic stroke, Prehospital delay, stroke knowledge, stroke attitudes, China
Received: 19 Jul 2025; Accepted: 10 Sep 2025.
Copyright: © 2025 Wu, Zhou, Xia, Wan, Fan, Jiang, Wang, Wang and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Guangming Xia, Huanggang Central Hospital, Huanggang, China
Feng Wan, Huanggang Central Hospital, Huanggang, China
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