Abstract TP243: IMPACT: Influence of Multiple Process of care Assessment times on Cerebral ischemia Treatment and outcomes
Background: Get With the Guidelines (GWTG) emphasizes a focus on process of care times in the acute stroke evaluation to optimize door to needle time. We looked at acute process of care time points to evaluate individual impact on time to treatment and 90 day outcome.
Methods: The UCSD SPOTRIAS prospectively collected database was analyzed for patients seen in acute stroke code, excluding inpatient codes. Multivariable regression models using an independent variable of 90 day mRS were used. Groups were defined as ≤/ > GWTG time points: arrival to stroke code 10 minutes, arrival to neurologic exam 15 minutes, arrival to imaging 25 minutes, and arrival to lab results 45 minutes. Models were adjusted for pre-specified covariates: pre-stroke mRS, age, gender, smoking, baseline NIHSS and glucose, and IV tPA.
Results: We analyzed 2903 patients- 481 treated with IV tPA, and 1023 with 90 day outcomes. All timeline goals led to significantly shorter arrival to decision times (all p<0.0001). These timepoints were also associated with decreased arrival to treatment time in IV tPA treated patients (all p<0.0001). However, after adjusting for baseline characteristics, no significant difference in 90 day mRS was observed in any comparison. Good outcome was more frequent with time to treatment ≤ 60 minutes (50.91% vs 41.76%, p=0.0522).
Conclusions: Time to decision and treatment were significantly shorter when the Get With the Guidelines timeline was followed. This reinforces that each aspect of the acute stroke evaluation must be efficient to expedite time to treatment. No difference was seen in 90 day outcome despite an expedited acute evaluation, emphasizing the importance of symptom onset to treatment time, and especially onset to arrival time, as integral to patient outcome. Further analyses focusing solely on the acute ischemic stroke subset, particularly those arriving within the tPA treatment window, are ongoing.
- © 2012 by American Heart Association, Inc.