Delayed Presentation and Low Alberta Stroke Program Early CT Score (ASPECTS) in Acute Ischemic Stroke: Evidence from a Tertiary Hospital in Tanzania

Abstract Introduction: Stroke is a leading cause of death and disability. The Alberta Stroke Program Early computed tomography (CT) Score (ASPECTS) quantifies early ischemic changes on non-contrast CT and supports treatment decisions. This study examined factors associated with CT findings and ASPECTS in patients with acute ischemic stroke at a tertiary hospital in Tanzania. Methods: A cross-sectional study was conducted among 172 patients with acute ischemic stroke who underwent non-contrast brain CT. Data were analyzed using SPSS v. 23. Categorical variables were assessed using the Chi-square test and continuous variables were assessed using the Student’s t -test. Multivariable regression analysis was performed to identify predictors of ASPECTS ( P < 0.05). Independent variables included age, sex, hypertension, diabetes, smoking status, and travel distance to hospital. The dependent variable was ASPECTS. Results: The mean age was 57.3 years, with a slight female predominance. Most patients (78.5%) had low ASPECTS, indicating extensive early ischemic changes. Presentation was frequently delayed: the majority arrived more than 24 h after symptom onset, and only 2.3% presented within 3 h. Delayed arrival was associated with lower ASPECTS and reduced eligibility for reperfusion therapy. Conclusions: Patients with acute ischemic stroke in this setting commonly present late and with low ASPECTS. These findings point to the need for improved early recognition, timely referral, and organized stroke care pathways.