Authorized surrogate presence and its association with early in-hospital delays and outcomes in acute ischemic stroke

Patient informed consent and decision-making continue to be significant factors impeding the efficiency of fast tacking of acute ischemic stroke (AIS). To date, no studies have explored the role of accompanying authorized surrogates in the early emergency care timelines and outcomes. This study retrospectively reviewed patients with stroke and suspected patients with stroke presenting to the emergency department of a stroke center (2023–2026), to assess the effects of authorized surrogate on time intervals and prognostic indicators. Among 381 patients with AIS, the rate of adequate to medical order time (< 10 min) was 84.5% (322 of 381), and the rate of adequate to CT imaging time (< 25 min) was 46.5% (177 of 381). Thrombolysis and interventional therapy were performed in 64 (62.1%) and 12 (23.5%) patients, respectively, exclusively when an authorized surrogate was present. Analysis of the time metrics revealed the longest delays across all measured intervals (medical order, CT imaging, thrombolysis, interventional therapy, and total emergency care times) in patients who presented alone, followed by those with a spouse as a surrogate. ΔNIHSS scores showed significant differences among patients with different types of accompanying authorized surrogates (P = 0.038). Initial NIHSS scores were significantly higher in patients with AIS who agreed to thrombolysis and endovascular intervention than in those who refused these procedures (P < 0.05). This study provides evidence that early in-hospital delay in patients with AIS is multifactorial and that the type of accompanying authorized surrogate is a critical and often overlooked factor influencing the efficiency of emergency treatment pathways in patients with AIS. The accompanying authorized surrogate plays a crucial role throughout the entire treatment process for patients with AIS. Meanwhile, the effect of the type of authorized accompanying surrogate on outcomes in AIS needs to be further validated.