Diagnostic delay and predictors of true stroke among patients with suspected in-hospital stroke: a single-center retrospective study
5 affiliations
- 1Department of Comprehensive Strokology, Fujita Health University
- 2School of Medicine, Fujita Health University
- 3Department of Neurosurgery, Fujita Health University
- 4Department of Emergency and General Internal Medicine, Fujita Health University
- 5Department of Anesthesiology and Critical Care Medicine, Fujita Health University
Abstract
Background: Timely diagnosis is essential for acute treatment of in-hospital stroke. We aimed to investigate factors associated with diagnostic delay and clinical predictors of true stroke among patients with suspected in-hospital stroke.
Methods: In this single-center retrospective study, we screened head computed tomography and magnetic resonance imaging orders between Jan 2023 and Jan 2026 for patients hospitalized outside the Departments of Neurology and Neurosurgery who developed new neurological symptoms within 24 h of symptom onset or last known well and were clinically suspected of having in-hospital stroke. Multivariable analyses were performed to identify factors associated with diagnostic delay and true stroke.
Results: A total of 183 patients (110 men, median age 77 years) were included. Median time from last known well to imaging-based final diagnosis was 292 min. Overall, 77 patients (42.1%) had true stroke, including 70 ischemic strokes, 5 intracerebral hemorrhages, and 2 subarachnoid hemorrhages. Wake-up symptom onset [Exp (β) 3.34, 95% confidence interval (CI) 2.61–4.28] and initial medical emergency team activation [Exp (β) 0.71, 95% CI 0.56–0.91] were associated with diagnostic delay. Persistent neurological symptoms [odds ratio (OR) 1.44, 95% CI 1.24–1.68] and FAST-positive symptoms (OR 1.28, 95% CI 1.12–1.46) were associated with true stroke. Among the 70 patients with ischemic stroke, 17 (24.3%) underwent reperfusion therapy.
Conclusion: Wake-up symptom onset and medical emergency team activation were associated with diagnostic delay, whereas persistent and FAST-positive symptoms were associated with true stroke. These findings may facilitate earlier recognition and improve triaging patients with suspected in-hospital stroke.
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BibTeX
@article{tanaka2026diagnostic,
title = {{Diagnostic delay and predictors of true stroke among patients with suspected in-hospital stroke: a single-center retrospective study}},
author = {Koji Tanaka and Ko Nakamura and Yuina Mori and Junpei Koge and Tetsuya Hashimoto and Eiji Fujiwara and Kiyonori Kuwahara and Mitsunaga Iwata and Tomoyuki Nakamura and Yuichi Hirose and Shoji Matsumoto},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1979991},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1979991/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Diagnostic delay and predictors of true stroke among patients with suspected in-hospital stroke: a single-center retrospective study
AU - Koji Tanaka
AU - Ko Nakamura
AU - Yuina Mori
AU - Junpei Koge
AU - Tetsuya Hashimoto
AU - Eiji Fujiwara
AU - Kiyonori Kuwahara
AU - Mitsunaga Iwata
AU - Tomoyuki Nakamura
AU - Yuichi Hirose
AU - Shoji Matsumoto
PY - 2026
DA - 2026/10/22
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1979991
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1979991/full
AB - Background: Timely diagnosis is essential for acute treatment of in-hospital stroke. We aimed to investigate factors associated with diagnostic delay and clinical predictors of true stroke among patients with suspected in-hospital stroke. Methods: In this single-center retrospective study, we screened head computed tomography and magnetic resonance imaging orders between Jan 2023 and Jan 2026 for patients hospitalized outside the Departments of Neurology and Neurosurgery who developed new neurological symptoms within 24 h of symptom onset or last known well and were clinically suspected of having in-hospital stroke. Multivariable analyses were performed to identify factors associated with diagnostic delay and true stroke. Results: A total of 183 patients (110 men, median age 77 years) were included. Median time from last known well to imaging-based final diagnosis was 292 min. Overall, 77 patients (42.1%) had true stroke, including 70 ischemic strokes, 5 intracerebral hemorrhages, and 2 subarachnoid hemorrhages. Wake-up symptom onset [Exp (β) 3.34, 95% confidence interval (CI) 2.61–4.28] and initial medical emergency team activation [Exp (β) 0.71, 95% CI 0.56–0.91] were associated with diagnostic delay. Persistent neurological symptoms [odds ratio (OR) 1.44, 95% CI 1.24–1.68] and FAST-positive symptoms (OR 1.28, 95% CI 1.12–1.46) were associated with true stroke. Among the 70 patients with ischemic stroke, 17 (24.3%) underwent reperfusion therapy. Conclusion: Wake-up symptom onset and medical emergency team activation were associated with diagnostic delay, whereas persistent and FAST-positive symptoms were associated with true stroke. These findings may facilitate earlier recognition and improve triaging patients with suspected in-hospital stroke.
SN - 1664-2295
ER -