This study evaluates how prehospital care factors, including stroke awareness, emergency response, transport, and referral processes, impact patient outcomes in acute stroke cases.

The research is a population-based observational cohort study conducted at Assiut University Hospital's Neuropsychiatry Department. It investigates patterns of prehospital stroke care with a focus on patient and caregiver awareness of stroke symptoms, the type of first medical contact, transport modes, referral pathways, and emergency medical service response. The study aims to understand how these prehospital factors influence stroke outcomes, including timely access to treatment, functional recovery, and mortality rates. Standardized tools, structured questionnaires, EMS records, and hospital medical data will be used to collect comprehensive information.

Inclusion Criteria:

• Adults ≥18 years of age

Confirmed diagnosis of acute stroke (ischemic/hemorrhagic) verified by CT or MRI

Residents of the study's defined geographical area

Patients who experienced stroke and sought prehospital care pathways (EMS or direct hospital presentation)

Informed consent from the patient or legally authorized representative

Exclusion Criteria:

• Patients with transient ischemic attack (TIA) or stroke mimics without confirmed acute stroke diagnosis

Missing or incomplete data on prehospital care

Patients unable or unwilling to provide consent without a representative available

Non-residents or visitors outside the designated geographical area

Participants are adult patients aged 18 years and above with an acute ischemic or hemorrhagic stroke diagnosis confirmed by neuroimaging. All patients must reside within the defined geographical area and have used emergency medical services or presented directly with stroke symptoms. Caregivers will also provide data regarding symptom recognition and decision-making. Patients with stroke mimics, incomplete records, or without consent will be excluded.