{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T05:10:45Z","timestamp":1778217045446,"version":"3.51.4"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite the widespread establishment of stroke centers, delays in pre-hospital and in-hospital care persist. To date, no studies have investigated the role of accompanying authorized surrogates in early emergency care timelines and the outcomes of acute stroke. This study aimed to analyze the influence of types of surrogate decision-maker on critical time intervals and early clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study was conducted in patients with acute stroke or those with suspected stroke admitted to a stroke center. The correlation between the type of accompanying authorized surrogate at patient admission and both early in-hospital emergency timelines [medical order, computed tomography (CT) imaging and emergency treatment times] and early prognosis (neurological outcome, incidence of adverse events) was analyzed using statistical methods, including univariate and multivariate regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 508 patients were managed via the stroke fast-track; among these, 414 were diagnosed with acute stroke. The type of accompanying authorized surrogate significantly influenced all in-hospital treatment time metrics. Patients without a surrogate decision-maker experienced significantly longer orders, CT imaging, and emergency treatment times than those with a surrogate (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). Notably, patients whose colleague or friend was the surrogate decision-maker had the shortest in-hospital emergency treatment time (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). Patients who sought medical care alone had the shortest length of hospital stay, lowest incidence of adverse events, and best neurofunctional outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early in-hospital delays in patients with acute stroke are multifactorial. The presence and type of accompanying authorized surrogates have a considerable effect on in-hospital emergency treatment time for acute stroke. However, the type of accompanying authorized surrogate showed a weak correlation with early prognosis in patients with acute stroke.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1757307","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T04:34:09Z","timestamp":1778214849000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Critical role of accompanying authorized surrogates among the multifactorial determinants of in-hospital delays in patients with acute stroke"],"prefix":"10.3389","volume":"17","author":[{"given":"Haoyu","family":"Wang","sequence":"first","affiliation":[{"name":"Emergency Department, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"Emergency Department, Chengdu Shangjin Nanfu Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Ni","sequence":"additional","affiliation":[{"name":"Emergency Department, Chengdu Shangjin Nanfu Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yao","family":"Chen","sequence":"additional","affiliation":[{"name":"Emergency Department, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"Emergency Department, Chengdu Shangjin Nanfu Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haifang","family":"Yu","sequence":"additional","affiliation":[{"name":"Emergency Department, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"Emergency Department, Chengdu Shangjin Nanfu Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yarong","family":"He","sequence":"additional","affiliation":[{"name":"Emergency Department, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"Emergency Department, Chengdu Shangjin Nanfu Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.1001\/jama.2020.26867","article-title":"Diagnosis and management of transient ischemic attack and acute ischemic stroke: a review","volume":"325","author":"Mendelson","year":"2021","journal-title":"JAMA"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3438","DOI":"10.18632\/aging.101657","article-title":"Trends in stroke incidence among elderly low-income residents of rural China: a population-based study from 1992 to 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