Supplementary Material for: Factors affecting prehospital delay in patients with acute ischemic stroke in the Republic of Georgia: a country-wide, prospective study

Introduction: Recently, a nationwide stroke care consisting of stroke care units (SCU) and stroke centers (SC) was established in the Republic of Georgia. Patients and Methods: A hospital-based prospective registry to evaluate the quality of stroke care and additional nation-wide survey on factors leading to prehospital delay and subsequent low rate of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT). Results: 5385 consecutive patients with acute stroke (3636 ischemic, 1302 TIA, 447 hemorrhagic) were included in the stroke registry, of whom 2459 (46%) were female, mean age 70.3+/-11.3years. 1538 (28.6%) patients presented < 6 hours (1160 (21.5%) < 4.5 hours). Of 3636 patients with ischemic stroke, 121 (3.3%) patients received IVT, 72 (2.0%) received EVT and 17 (0.5%) received both. Additional 1067 patients with acute ischemic stroke (898) and TIA (169) were interviewed to understand the factors of prehospital delay. Of these, 472 (44.2%) were female, mean age 70.5±11.4 years, and 339 (31.8%) patients arrived < 6 hours (219 (20.5%) <4.5 hours). Forty-two patients (4.7%) received IVT, 37 (4.1%) received EVT and 6 (0,7%) received both. Pre-ictal education level, high socio-economic status, stroke awareness, calling the ambulance, and a knowledgeable ambulance team transferring patients to the stroke-ready hospital predicted timely arrival at the stroke center. Conclusions: The study reveals major problems in the prehospital management of acute stroke. Discussion: There is a great need for a nation-wide geographic transfer plan for acute stroke service, connecting ambulances, SCUs and SC and for the educational campaigns to increase stroke awareness among the population.