Acute stroke care pathways are complex and influenced by various factors at different stages. This systematic review aims to provide a comprehensive analysis of existing literature, exploring factors influencing acute stroke pathways and elucidating their interrelations. A systematic search of PubMed, Embase, and Cochrane Library was conducted, identifying 29 reviews published in English. Inclusion criteria focused on studies related to acute stroke pathways, considering factors at pre-hospital and in-hospital stages. Quality assessment and data extraction were performed, categorizing factors into patient, space, organizational/logistical, and training. Associations between factors were analyzed, both between and within categories. The review identified diverse factors influencing acute stroke pathways. Patient factors, such as stroke knowledge and bystander presence, were consistently cited. Space-related factors included the impact of distance on delays. Organizational/logistical aspects, including pre-notification and CT scan availability, played crucial roles. Training factors, especially stroke recognition, significantly influenced pre-hospital stages. Associations were observed both between and within categories, revealing intricate dynamics. The study concludes that acute stroke delays are multifactorial, involving patient, space, organizational/logistical, and training aspects. The findings emphasize the need for a systemic approach, considering the dynamic interplay of these factors. Multi-factorial interventions, as demonstrated in some studies, show promise in addressing barriers across the stroke pathway. Understanding contextual influences is crucial for effective acute stroke care planning. Further research should explore less-studied factors, contributing to a more nuanced understanding of acute stroke care complexities.
Key words: Systematic review, stroke patients, emergency department, emergency, delayed presentation, risk factors.
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