Timeliness and Effectiveness of Stroke Care in the Emergency Department

Authors

  • Muhammad Abas Khan Assistant Professor, Emergency Department, Lady Reading Hospital, Peshawar, Pakistan Author
  • Mahwish Khan Medical Officer, Tehsil District Hospital, Khanpur, Haripur, Pakistan Author
  • Maryam Gul Emergency Medical Officer, Lady Reading Hospital, Peshawar, Pakistan Author
  • Aamir Shehzad Postgraduate Resident, Medical C Unit, Lady Reading Hospital, Peshawar, Pakistan Author
  • Abdul Wadood Trainee Medical Officer, Medical Ward, Lady Reading Hospital, Peshawar, Pakistan Author
  • Jalal Khan Postgraduate Resident Emergency Medicine, Lady Reading Hospital MTI, Peshawar, Pakistan Author
  • Eesha Afridi House Officer, Jinnah Postgraduate Medical Center (JPMC), Karachi, Pakistan Author

DOI:

https://doi.org/10.61919/7wd9qj13

Keywords:

Stroke, Emergency Department, Timeliness, Thrombolysis, Door-to-Needle Time, Prehospital Delay, Stroke Pathway

Abstract

Background: Acute stroke outcomes are critically dependent on time to diagnosis and treatment, with each minute of delay leading to irreversible neuronal loss. Despite international benchmarks emphasizing door-to-imaging ≤25 minutes and door-to-needle ≤60 minutes, delays remain widespread in low- and middle-income countries, including Pakistan. Objective: To assess the timeliness and effectiveness of acute stroke management in the Emergency Department of Lady Reading Hospital, Peshawar, focusing on prehospital and in-hospital time intervals and their association with early neurological outcomes. Methods: A prospective observational study was conducted from October 2024 to January 2025, enrolling 300 adults presenting within 24 hours of stroke onset. Time intervals—onset-to-door, door-to-imaging, and door-to-needle—were recorded. Effectiveness was evaluated by adherence to international targets and early neurological improvement (NIHSS reduction ≥4). Data were analyzed using SPSS 26, applying t-tests, χ² tests, and multivariate logistic regression. Results: The median onset-to-door time was 160 minutes, and mean door-to-imaging and door-to-needle times were 38 ± 18 and 62 ± 19 minutes, respectively. Only 52% achieved imaging ≤25 minutes, and 46.6% received thrombolysis within 60 minutes. Door-to-imaging ≤25 minutes (OR 2.83, 95% CI 1.43–5.61) and door-to-needle ≤60 minutes (OR 2.32, 95% CI 1.09–4.94) independently predicted early neurological improvement. Conclusion: Significant prehospital and imaging delays limited timely reperfusion despite efficient triage. Implementing structured stroke-fast-track pathways, EMS prenotification, and prioritized neuroimaging could substantially enhance both timeliness and early outcomes in tertiary emergency care in Pakistan.

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Published

2025-10-15

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Section

Articles

How to Cite

1.
Muhammad Abas Khan, Mahwish Khan, Maryam Gul, Aamir Shehzad, Abdul Wadood, Jalal Khan, et al. Timeliness and Effectiveness of Stroke Care in the Emergency Department. JHWCR [Internet]. 2025 Oct. 15 [cited 2025 Oct. 20];3(14):e857. Available from: https://jhwcr.com/index.php/jhwcr/article/view/857

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