Objective To explore key risk factors associated with hospital delay among stroke patients, and to lay basis for targeted risk management strategies. Methods Through literature review, expert interview and consultation， a questionnaire containing 44 risk factors associated with hospital delay among stroke patients were formed. The questionnaire was issued to 447 stroke patients and 202 doctors, who were asked to rate the importance of each risk factor through subjective assessment method and TOPSIS method. By integrating the results of the 2 methods, key risk factors were extracted based on 80-20 rule (aka Pareto Principle) .Results A total of 16 key risk factors were extracted from 44 risk factors: 7 factors in patient delay stage, 4 factors in transport delay stage, and 5 factors in in-hospital delay stage. Conclusion Hospital delay for stroke patients involved a variety of factors. A multi-dimensional and whole-process risk management mechanism should be built for stroke patient. Aiming at the 16 key factors, we also need to improve patients′coping against individual risks, enhance the utilization of 120 emergency system by the patients, and ameliorate medical treatment procedures and policies.