Abstract Number: Esoc2026a2301 Prehospital Time Intervals in Stroke Patients Eligible for Mechanical Thrombectomy in a Rural Telemedicine Network

Abstract Background and aims Early treatment is critical for favorable outcomes in acute ischaemic stroke, particularly in patients eligible for endovascular treatment (EVT). While in-hospital delays are well studied, the structure and relative contribution of specific pre-hospital pathways are less well characterized, particularly within telemedicine-supported stroke networks. We aimed to study and characterize key pre-hospital stroke time intervals and to explore whether current care pathways allow timely hospital arrival at the primary stroke center. Methods We conducted a retrospective observational analysis of EVT-eligible stroke patients receiving telemedicine consultation within a regional network between February 1, 2018 and December 31, 2025. Several pre-hospital time intervals were evaluated. Intervals are reported as medians with interquartile ranges (IQR). Exploratory stratified analyses were performed for selected patient- and system-level variables. Results Among 2,506 patients, 88% were transported by EMS (3.8% not transported, 8.2% not documented). Overall median onset-to-door time was 104 minutes (IQR 60-338). Median time from detection of symptoms to call for EMS was 16 minutes (IQR 5-45) and call-to-door time was 44 minutes (IQR 34-55). Median detection-to-door time was 65 minutes (IQR 48-97), and was comparable in patients transported with and without EMS. Stratified analyses across selected patient and system characteristics showed largely consistent pre-hospital time intervals. Conclusions A substantial amount of time is consumed before hospital arrival. Pre-hospital delays represent a major contributor to time loss. The uniformity of pre-hospital time intervals across subgroups suggests that the potential for further improvement is limited. Future strategies should aim to extend diagnostics and treatment into the pre-hospital phase. Conflict of interest All authors: nothing to disclose.