Diagnostic Delays in Acute Care Settings in Clinics in Damascus University Affiliated Hospitals: A Cross-Sectional Study of Patient- and Systemic-Related Factors

Background : Diagnostic delay is a critical issue in healthcare, yet evidence from conflict-affected settings such as Syria is scarce. This study quantifies diagnostic delays and identifies their predictors within the Syrian healthcare system. Methods : A cross-sectional study was conducted (July–October 2025) at three major hospitals in Damascus. We administered the questionnaire to 250 adult patients presenting with new-onset acute symptoms, 233 of whom were included in the final study. A structured questionnaire administered by trained research staff at the point of care, informed by established health services frameworks, collected data on sociodemographic factors, health literacy, and healthcare processes. The primary outcomes were patient delay (symptom onset to first healthcare contact) and systemic delay (first contact to diagnosis). Results : The mean total diagnostic delay was 12·6 days (±9·2), comprising similar mean patient (6·1 days ±8·1) and systemic (6·5 days ±7·0) delays. Multivariable analysis revealed that patient delay was independently predicted by the use of home remedies (B=0·587, p<0·001) and lower confidence in needing care (B=-0·267, p=0·001). Systemic delay was driven primarily by longer laboratory test durations (B=0·140, p<0·001), appointment scheduling times (B=0·090, p=0·003), and higher direct costs (B=0·421, p=0·009). Conclusions : Diagnostic delays in Syria are a two-faceted problem stemming from health-seeking behaviors and systemic operational bottlenecks. Interventions must simultaneously promote timely care seeking through community engagement and addressing system inefficiencies, such as decentralizing diagnostics and reducing financial barriers, to improve outcomes in this conflict-affected setting.