Background and Aims
Few studies have examined the association between onset-to-arrival time and functional outcomes in acute ischaemic stroke, particularly in patients not receiving reperfusion therapy. Our study aims to investigate if early arrival to a hospital is associated with good functional outcome (mRS ≤ 1) at discharge. 

Method
Data were collected from the nationwide, registry-based Sentinel Stroke National Audit Programme. We included all adult patients aged >16 admitted to hospital with acute Ischaemic Stroke in England and Wales between the 1st of April 2013 and the 31st of March 2017. We used a multilevel logistic regression analysis to adjust for potential demographic (age, sex, ethnicity) and clinical (pre-stroke functional status, comorbidities, stroke severity, arrival by ambulance and reperfusion therapy) confounders at the patient level, as well as potential differences between centres.

Results
165,301 patients with ischaemic stroke from 224 different hospitals were included in the analysis. 85,427 (52%) were male, 146,179 (88%) were white, median NIHSS was on arrival was 4 (IQR: 2-10), and median onset-to-arrival time was 156 minutes (IQR: 82-474), with 49,021 patients arriving within 1.5 hours of stroke onset. After adjustment, patients arriving within 1.5 hours and between 1.5 and 3 hours after stroke onset had slightly increased odds of having a good functional outcome at discharge (OR 1.21 [95%CI 1.15-1.27] and 1.08 [95%CI 1.03-1.13]) compared to those arriving after 24 hours.

Conclusion
Early hospital arrival within 3.0 hours after ischaemic stroke onset is associated with good functional outcome at discharge even after adjusting for stroke severity and reperfusion therapy.

ASSOCIATION BETWEEN ONSET-TO-ARRIVAL TIME AND FUNCTIONAL OUTCOME AT DISCHARGE IN ACUTE ISCHAEMIC STROKE