{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:26:38Z","timestamp":1787030798757,"version":"build-2736575974"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"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:p>\n                    Stroke remains a leading cause of death and disability worldwide, and the \u201ctime-is-brain\u201d paradigm frames prehospital speed as the principal modifiable determinant of outcome. Data from Kazakhstan, a country of about 2.72 million km\n                    <jats:sup>2<\/jats:sup>\n                    with a population density of roughly 7 inhabitants per km\n                    <jats:sup>2<\/jats:sup>\n                    , are scarce, and it is unclear whether time metrics retain their prognostic role where most patients present outside reperfusion windows. We retrospectively analyzed 149 elderly patients (aged 57\u201375\u202fyears) with neuroimaging-confirmed acute stroke admitted to the National Coordination Center for Emergency Medicine (Astana, Kazakhstan) in 2025\u20132026; transient ischaemic attacks were excluded. Prehospital time, transport mode, reperfusion, neurological severity (NIHSS), comorbidity and in-hospital mortality were assessed using Spearman correlation, ANOVA and logistic regression. Ischemic stroke predominated (122\/149; 81.9%). The median onset-to-door time was 9.5\u202fh (IQR 3.0\u201348.3\u202fh; range 25\u202fmin to 264\u202fh), and only 36.5% arrived within the 4.5-h thrombolysis window; delays were longest in hemorrhagic stroke (median 24.8\u202fh). Reperfusion therapy reached 24.6% of ischemic-stroke patients (thrombolysis 9.0%, thrombectomy 15.6%), whereas 67.2% were managed conservatively. Despite these delays, in-hospital mortality was low (6.8%). Onset-to-door time predicted neither in-hospital death (adjusted OR 1.00 per hour;\n                    <jats:italic>p<\/jats:italic>\n                    \u202f=\u202f0.99) nor discharge functional status (modified Rankin Scale\n                    <jats:italic>r<\/jats:italic>\n                    \u202f=\u202f\u22120.013,\n                    <jats:italic>p<\/jats:italic>\n                    \u202f=\u202f0.87); in a pre-specified Firth penalized model the predictors of death were baseline NIHSS (penalized OR 1.22 per point; 95% profile-likelihood CI 1.12\u20131.37;\n                    <jats:italic>p<\/jats:italic>\n                    \u202f&amp;lt;\u202f0.001) and cardiac arrhythmia (penalized OR 5.51; 95% CI 1.07\u201329.71;\n                    <jats:italic>p<\/jats:italic>\n                    \u202f=\u202f0.041). The crude mortality contrast (29.4% vs. 3.8%) is descriptive and hypothesis-generating. Baseline NIHSS was inversely correlated with onset-to-door time (\n                    <jats:italic>r<\/jats:italic>\n                    \u202f=\u202f\u22120.193;\n                    <jats:italic>p<\/jats:italic>\n                    \u202f=\u202f0.019), indicating that later-presenting patients were less severely affected. These findings apply specifically to elderly patients who survived to reach the center and are not causal: the severity\u2013time and time\u2013mortality associations reflect who reaches the center. Within this hospital-admitted cohort, in-hospital mortality appears governed by neurological severity and cardiac comorbidity rather than transport time, supporting risk-based triage, arrhythmia detection, regionalized routing and air-ambulance capacity alongside efforts to compress door times.\n                  <\/jats:p>","DOI":"10.3389\/fneur.2026.1916069","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:28:25Z","timestamp":1787027305000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the golden hour: prehospital delay and in-hospital stroke mortality in an elderly cohort reaching a national emergency-medicine center in Kazakhstan"],"prefix":"10.3389","volume":"17","author":[{"given":"Aigul A.","family":"Abduldayeva","sequence":"first","affiliation":[{"name":"Laboratory of Health, Research Institute of Preventive Medicine, NCJSC \u201cAstana Medical University\u201d","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliya M.","family":"Omarbek","sequence":"additional","affiliation":[{"name":"Laboratory of Health, Research Institute of Preventive Medicine, NCJSC \u201cAstana Medical University\u201d","place":["Astana, Kazakhstan"]},{"name":"National Coordination Center for Emergency Medicine","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gulnur N.","family":"Doszhanova","sequence":"additional","affiliation":[{"name":"Laboratory of Health, Research Institute of Preventive Medicine, NCJSC \u201cAstana Medical University\u201d","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yerzhan B.","family":"Adilbekov","sequence":"additional","affiliation":[{"name":"National Coordination Center for Emergency Medicine","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolay A.","family":"Safonov","sequence":"additional","affiliation":[{"name":"Laboratory of Health, Research Institute of Preventive Medicine, NCJSC \u201cAstana Medical University\u201d","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saule A.","family":"Iskakova","sequence":"additional","affiliation":[{"name":"Laboratory of Health, Research Institute of Preventive Medicine, NCJSC \u201cAstana Medical University\u201d","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1016\/S1474-4422(24)00369-7","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132021: a systematic analysis for the global burden of disease study 2021","volume":"23","year":"2024","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1177\/17474930241308142","article-title":"World stroke organization: global stroke fact sheet 2025","volume":"20","author":"Feigin","year":"2025","journal-title":"Int J Stroke"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e74","DOI":"10.1016\/S2468-2667(21)00230-9","article-title":"Primary stroke prevention worldwide: translating evidence into action","volume":"7","author":"Owolabi","year":"2022","journal-title":"Lancet Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"I","DOI":"10.1177\/2396987321989865","article-title":"European stroke organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke","volume":"6","author":"Berge","year":"2021","journal-title":"Eur Stroke 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stroke","volume":"150","author":"Royan","year":"2024","journal-title":"Circulation"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"765","DOI":"10.14423\/SMJ.0000000000001601","article-title":"Community socioeconomic and urban-rural disparities in prehospital notification of stroke by emergency medical services in North Carolina","volume":"116","author":"Shams","year":"2023","journal-title":"South Med J"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"3605","DOI":"10.1161\/STROKEAHA.122.039825","article-title":"Evaluating the diagnostic performance of prehospital stroke scales across the range of deficit severity: analysis of the Prehospital Triage of Patients with Suspected Stroke Study","volume":"53","author":"Ganesh","year":"2022","journal-title":"Stroke"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1177\/1357633X231204066","article-title":"Prehospital stroke scales outperform the National Institutes of Health stroke scale in predicting large vessel occlusion in a large academic telestroke network","volume":"31","author":"English","year":"2023","journal-title":"J Telemed Telecare"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e026834","DOI":"10.1161\/JAHA.122.026834","article-title":"Emergency medical services stroke care performance variability: analysis of a statewide linked stroke registry","volume":"12","author":"Oostema","year":"2023","journal-title":"J Am Heart Assoc"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"8109173","DOI":"10.1155\/ijcp\/8109173","article-title":"Evaluation of stroke care delivery: 12-month experience of a tertiary stroke center in Central Asia","volume":"2025","author":"Grigolashvili","year":"2025","journal-title":"Int J Clin Pract"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e18435","DOI":"10.1016\/j.heliyon.2023.e18435","article-title":"Improving multidisciplinary hospital care for acute cerebral circulation disorders in 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Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1916069\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:28:26Z","timestamp":1787027306000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1916069\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":26,"alternative-id":["10.3389\/fneur.2026.1916069"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1916069","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"article-number":"1916069"}}