Abstract 3243: A Comparison of Vascular Neurologist Interpretation versus Radiology Reports of Computed Tomographic Imaging for Determining Eligibility of Intravenous Thrombolysis in Patients with Acute Ischemic Stroke
Background: Computed tomographic (CT) scan is the gold standard imaging for determining acute ischemic stroke patient eligibility for intravenous thrombolysis (IV t-PA). In most institutions neurologists or clinicians interpret the intial CT images to determine eligibility, although some institutional protocols require the neuroradiologist interpretation.
Objective: To evaluate the variability of determining eligibility for IV rt-PA by vascular neurologist interpretation of CT scan versus review of the radiology interpretation (presented in final report) in patients with acute ischemic stroke.
Methods: We compiled a database of all IV rt-PA treated ischemic stroke patients at our academic institutions based on vascular neurologists’ CT scan interpretation . The patients’ CT scan reports were reviewed by an independent board certified vascular neurologist who was blinded to all clinical information except that all patients were being considered for IV rt-PA to determine eligibility for IV rt-PA. The reviewer’s responses were then compared with the treating team’s decision to identify discrepancy between decisions and assess impact on clinical outcome (including 24 hour NIHSS score and discharge modified Rankin scale), symptomatic hemorrhage (sICH), and asymptomatic hemorrhage (aICH).
Results: A total of 171 acute ischemic stroke patients, were included in the study and had received IV rt-PA. The mean age (±SD) was 61±14 years, the mean (±SD) NIHSS score was 7±2. The independent reviewer decided to treat with IV t-PA in 123 (72%) of cases after review of radiology reports. The most common reasons for deciding against thrombolysis were findings of early ischemic changes, possible established infarct, or inability to exclude ICH in the radiology report. Assuming equal variances, the clinical improvement based on NIHSS and mRS at discharge, sICH, and aICH were not significantly different with IV rt-PA treatment between those who were treated but would be excluded and those who will be included based on a review of radiology reports.
Conclusion: The study demonstrates that administering IV rt-PA to patients based on vascular neurologist interpretation of CT scan versus review of the radiology interpretation does not lead to significant differences in clinical outcome, aICH, or sICH and should not be a pre-requisite to avoid delays in IV rt-PA administration.
- © 2012 by American Heart Association, Inc.