Abstract Body: Introduction: The social environment plays an essential role in a patient’s arrival time to the hospital when experiencing medical emergencies. For stroke events an understanding of these socio-ecological factors may provide insight on eligibility for time-based interventions. This study aimed to assess the relationship between the first person made aware during a stroke and the impact on a patient’s hospital arrival timeliness.

Methods: Time is Brain is a multi-center observational study assessing the role of social network mechanisms involved in delays to the hospital. As part of this study, we enrolled patients who had an acute stroke syndrome within the past seven days and received hospital care at either Mass General Brigham or Yale New Haven Hospital. We collected data on the social circumstances and the decision-making during the acute stroke in the community. We asked participants: 1. Did you tell anyone about your symptoms? 2. If yes, who did you tell about these symptoms? 3. Did anyone other than yourself notice symptoms? 4. If yes, who noticed your symptoms? We combined the responses for these questions into the first person aware of symptoms. The categories for people first aware were family members, spouse, co-worker/friend/stranger, and no one made aware. Here, we describe the median last known well to hospital arrival time and the median symptom onset to hospital arrival for each of these categories.

Results: In 181 patients, we found that 72 (39.6%) individuals identified a spouse, 51 (28.2%) identified a family member, 33 (18.2%) identified a co-worker, friend, or stranger, and 25 (13.8%) did identified no one. Patients who reached out to friends, co-workers, or strangers had a median last known well to hospital arrival time of 180 minutes and a median symptom onset to hospital arrival time of 92 minutes. In contrast, arrival times were longest for those who contacted family with a median last known well to hospital arrival time of 615 minutes and median symptom onset to hospital arrival time of 120 minutes.

Conclusion: The decision to seek care during stroke usually includes family or lay others. This preliminary analysis suggests that who is involved may influence the time to arrival to the hospital and ultimately improve individual stroke recovery. When considering how to improve arrival times, this multi-person decision-making process should be a factor in intervention development.