To describe the protocol for a scoping review that will map existing evidence on door-to-computed tomography (DTC) intervals in acute stroke management across sub-Saharan Africa.

Timely neuroimaging is essential for diagnosing stroke type and initiating reperfusion therapy, with global benchmarks recommending brain imaging within 25 minutes of arrival. However, emerging studies from sub-Saharan Africa indicate that patients often wait many hours or even days for CT imaging. Despite multiple reports of prolonged imaging times, there is no comprehensive synthesis quantifying DTC delays, identifying system-level barriers, or evaluating interventions designed to improve imaging timeliness in the region.

This ongoing review follows the Arksey and O’Malley framework and PRISMA-ScR guidelines. A comprehensive search of PubMed, African Journals Online, Scopus, and grey literature (including WHO and Ministry of Health reports) includes English-language studies published between 2000 and 2025. Eligible studies report quantitative DTC times or describe factors or interventions affecting stroke imaging workflow among adult patients in any hospital level. Data are being extracted on study design, setting, DTC intervals, and key barriers.

To date, 10 studies from eight countries (Nigeria, Ghana, Senegal, Burkina Faso, Ethiopia, Mozambique, Côte d’Ivoire, and South Africa) have been identified. Reported median DTC intervals ranged from 4 to over 24 hours, with less than 5% of patients scanned within one hour of arrival. Common barriers include limited CT availability, after-hours service gaps, out-of-pocket costs, and absence of organized stroke pathways. Only a few studies described structured interventions, such as stroke units or multidisciplinary teams, with limited evaluation of their impact on imaging time.

Preliminary evidence demonstrates profound imaging delays across sub-Saharan Africa, far exceeding global targets. This scoping review will provide the first regional synthesis of DTC intervals, highlighting critical system barriers and identifying research and policy priorities to improve timely stroke diagnosis and care delivery.