Methodology Factors Related to Prehospital Delay in the Presentation of Acute Stroke and Level of Awareness among Stroke Patients in a District Setting SH Lim1, TL Tan1, PW Ngo1, LY Lee1, SY Ting2, HJ Tan3 1Medical Department, Hospital Seri Manjung, Perak, Ministry of Health, Malaysia 2Clinical research Department, Hospital Seri Manjung, Perak, Ministry of Health, Malaysia 3Neurology Department, Hospital Kuala Lumpur, Kuala Lumpur, Ministry of Health, Malaysia P-152 NMRR-19-2047-49080 (IIR) Introduction • Early presentation to hospitals has been shown to predict better functional outcomes in stroke patients. • Lack of these local data poses great challenge in the mission of establishing more acute stroke ready hospitals among district populations. • Aims: To examine how stroke patients in district setting in Malaysia react to stroke symptoms and factors contributed to their prehospital delay to seek treatment. Characteristics n (%) Age in years, mean(SD) 59 (12.7) Male gender 65 (63.7) Ethnicity Malay Chinese Indian Others 67 (65.7) 26 (25.5) 7 (6.9) 2 (1.9) Comorbidities Hypertension Diabetes mellitus Dyslipidemia Ischemic heart disease Previous stroke None 73 (71.6) 39 (38.2) 29 (28.4) 15 (14.7) 18 (17.6) 21 (20.6) NIHSS score, median(IQR) 5 (6.0) Perception of stroke Yes No Not sure 39 (38.2) 21 (20.6) 42 (41.2) Patients’ perception of symptom & severity Limb weakness Severe Facial asymmetry Severe Dysarthria Severe 92 (89.3) 59 (57.8) 31 (30.1) 11 (10.8) 56 (54.4) 25 (24.5) Aware of thrombolysis service 4 (3.9) Subtype of stroke LACI PACI POCI TACI 82 (80.4) 11 (10.8) 6 (5.9) 3 (2.9) Decision delay in minutes, median(IQR) 120 (645.0) Transport delay in minutes, median(IQR) 161 (192.5) Prehospital delay in minutes, median(IQR) 364 (957.5) Table 1: Demographic and clinical characteristics Results Variables Adj. OR (CI 95%) P value Ethnicity Malay Chinese Indian Others 11.30 (1.93, 66.19) 4.06 (0.64, 25.65) 1.00 0.60 (0.02, 15.00) 0.019 0.007 0.136 0.753 No previous stroke 4.15 (1.21, 14.25) 0.024 Not aware of thrombolysis service 17.12 (1.28, 229.17) 0.032 Table 2: Significant predictors for PREHOSPITAL DELAY by multivariate logistic regression Variables Adj. OR (CI 95%) P value No comorbid 8.63 (1.40, 53.22) 0.020 NIHSS score 0.87 (0.78, 0.96) 0.006 Perception of stroke Yes No Unsure 1.00 3.67 (0.95, 14.17) 3.78 (1.24, 11.55) 0.040 0.059 0.020 Not aware of thrombolysis service 15.27 (1.10, 211.46) 0.042 Table 3: Significant predictors for DECISION DELAY by multivariate logistic regression 1. Patients without any comorbidity had higher likelihood of decision delay as they were never screened for any cardiovascular risk factors or received any clinic consultations prior to stroke. 2. No association was found between having at least one cardiovascular risk factor with prehospital or decision delay, suggesting the lack of stroke education for patients who are at risk of stroke. 3. Our study population had poor awareness and knowledge for stroke as evidenced by less than half of the patients were able to recognize FAST symptoms as stroke. 4. Those who perceived stroke symptoms correctly had shorter decision time compared to those who were unsure, but the former did not have shorter prehospital delay. This shows that even good knowledge of stroke symptoms is insufficient as there was a significant discrepancy between awareness and action taken following stroke. 5. Reasons for decision delay were symptoms being mild, unable to get help, symptoms being perceived as self-limiting and not knowing how to react. 6. Decision delay is not significantly shorter in patients who perceived their symptoms to be severe. In conclusion, there is a substantial lack of knowledge and lackluster response to stroke among our studied populations. Various strategies are required in the future not only to disseminate knowledge of stroke, but also to modulate the public behaviour as these represent the main obstacles towards early hospital presentation a