This Article Full Text Full Text (PDF) All Versions of this Article: 39/12/3262    most recent STROKEAHA.108.524686v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rose, K. M. Articles by Tegeler, C. H. Search for Related Content PubMed PubMed Citation Articles by Rose, K. M. Articles by Tegeler, C. H. Pubmed/NCBI databases Medline Plus Health Information CT Scans Stroke Related Collections Emergency treatment of Stroke Computerized tomography and Magnetic Resonance Imaging

(Stroke. 2008;39:3262.)
© 2008 American Heart Association, Inc.

Original Contributions

Predictors of Time From Hospital Arrival to Initial Brain-Imaging Among Suspected Stroke Patients

The North Carolina Collaborative Stroke Registry

Kathryn M. Rose, PhD; Wayne D. Rosamond, PhD; Sara L. Huston, PhD; Carol V. Murphy, RN, MPH Charles H. Tegeler, MD

From the Department of Epidemiology (K.M.R., W.D.R., S.L.H., C.V.M.), School of Public Health, University of North Carolina, Chapel Hill; the Heart Disease & Stroke Prevention Branch (S.L.H.), NC Division of Public Health, Raleigh, N.C.; and the Department of Neurology (C.H.T.), Wake Forest University Baptist Medical Center, Winston-Salem, N.C.

Correspondence to Kathryn M. Rose, PhD, Department of Epidemiology, University of North Carolina at Chapel Hill, 137 E Franklin Street, Suite 306, Chapel Hill, NC 27514. E-mail kathryn_rose{at}unc.edu

Background and Purpose— We examined patient demographic and hospital characteristics and clinical predictors of delay time from hospital arrival until CT among 20 374 patients enrolled in the North Carolina Collaborative Stroke Registry (January 2005 to April 2008).

Methods— Delay time was log-transformed in linear regression analyses and dichotomized (25 minutes, >25 minutes) in logistic regression analyses to correspond to a 1999 National Institute of Neurological Disorders and Stroke guideline.

Results— In multiple linear regression analyses, prehospital delay time, mode of transport, race, gender, presumptive diagnosis, time of day of arrival, weekday versus weekend arrival, and hospital type (defined by Joint Commission Primary Stroke Center certification and teaching status) were significantly associated with CT delay. In analyses of 3549 patients arriving within 2 hours of symptom onset, time of day of arrival and weekday versus weekend arrival were no longer significant. Among patients arriving within 2 hours of symptom onset, the strongest independent predictors of meeting the National Institute of Neurological Disorders and Stroke (NINDS) guideline were arrival by emergency medical services versus other modes of transportation (odds ratio, 95% CI=2.3 [1.9, 2.8]) and a presumptive diagnosis of transient ischemic attack versus unspecified stroke type (odds ratio, 95% CI=0.4 [0.3, 0.5]).

Conclusions— Most patients do not arrive to the hospital in a timely manner and cannot be considered for time-dependent therapies. Among those that do, disparities exist in time to receipt of CT scan, suggesting room for improvement in hospital-level stroke systems of care.

Key Words: stroke • in hospital delay time • computer tomography

This article has been cited by other articles:

				L. D. Lisabeth, D. L. Brown, R. Hughes, J. J. Majersik, and L. B. Morgenstern Acute Stroke Symptoms: Comparing Women and Men Stroke, June 1, 2009; 40(6): 2031 - 2036. [Abstract] [Full Text] [PDF]

				J. W. Gargano, S. Wehner, and M. J. Reeves Do Presenting Symptoms Explain Sex Differences in Emergency Department Delays Among Patients With Acute Stroke? Stroke, April 1, 2009; 40(4): 1114 - 1120. [Abstract] [Full Text] [PDF]