Background: Although recent advances have been made in the treatment o
f acute stroke, patients often arrive at the hospital too late to rece
ive the maximum benefit from these new therapies. Objective: To invest
igate characteristics that influence the time from symptom onset to ho
spital arrival (delay time) for patients with acute stroke. Design: Re
trospective medical record review. Setting: Minneapolis-St. Paul metro
politan hospitals. Patients: A 50% random sample of all patients 30 to
79 years of age who were hospitalized with acute stroke from 1991 to
1993. Measurements: Patients were identified through discharge diagnos
is lists by using the International Classification of Diseases, 9th Re
vision. Trained nurses abstracted the medical records. Stroke events w
ere validated by using neuroimaging reports and additional clinical cr
iteria (1895 patients). An accelerated failure time model was used to
identify patient characteristics that independently predicted delay ti
me. For 70% of patients (n = 1334), delay time was calculated from the
medical record by subtracting the recorded time of symptom onset from
the admission time. For the remaining 30% of patients (n = 561), the
time of symptom onset was not recorded, and an approximate delay time
was estimated from all available information. Results: Among patients
with a calculated delay time, half arrived within 3 hours of symptom o
nset and 90% arrived within 24 hours. Patients with approximated delay
times tended to have longer delays, and less than 40% of these patien
ts arrived within 24 hours of symptom onset. Some characteristics asso
ciated (P < 0.05) with longer delay included Asian/Pacific Islander et
hnicity, dependence in any activities of daily living before stroke, a
nd several symptoms at stroke onset. Characteristics associated (P < 0
.05) with shorter delay included admission through the emergency depar
tment, presence of syncope or seizures at stroke onset, previous myoca
rdial infarction, abnormal mental status, and greater disability at pr
esentation (measured by the Rankin scale). Conclusions: Most patients
arrive at the hospital too late to receive the maximum benefit from em
erging stroke therapies. Efforts to reduce delays in hospital arrival
after acute stroke can maximize the effectiveness of these thera pies
by specifically targeting persons at risk for longer delay.