Abstract Number: Esoc2026a1221 Inequalities in the Acute Management of in-Hospital vs Out-of-Hospital Strokes in a Uk General Hospital

Abstract Background and aims In-hospital stroke (IHS) patients often receive delayed time-critical care and worse outcomes compared to community-onset strokes (COS). We examined discrepancies between IHS and COS in a UK General Hospital, comparing time to imaging, thrombolysis and admission to stroke unit. Methods Retrospective study of patients treated for a stroke at a UK General Hospital between 1st October 2024 and 30th September 2025. Outcomes were time from presentation to CT imaging ( 20 minutes, 1 hour), rate and timing of thrombolysis (1 hour), and time for admission to stroke unit (within 4 hours) as per UK National Guidelines. Results It took longer to obtain CT imaging for IHS than COS (3 hours 13 minutes vs 2 hours 2 minutes, p0.0012). A lower proportion of IHS patients met UK Standards for CT imaging within 1 hour compared to COS (37% vs 56%, p0.001) and similarly, less within 20 minutes (7.4% vs 27.4%, p0.001). Thrombolysis rates and timing was comparable between groups. Stroke unit admission took substantially longer for IHS than for COS; zero IHS were admitted to the stroke unit within 4 hours, compared to 41.9% of COS (two-tailed, p 1x10-10, 95% CI -49.1 to -35.0). Conclusions IHS strokes had worse outcomes associated with time to CT imaging and admission to a stroke unit compared to COS, consistent with previous literature. To address the discrepancies seen we have implemented education in downstream wards focusing on stroke recognition, management and key escalation steps as well as increasing the availability of stroke outreach and registrar staffing. Conflict of interest All authors - nothing to disclose