Abstract TP371: Does Symptom Onset to Primary Stroke Center Time Points Affect Stroke Outcome?
Background: Treating acute ischemic stroke (AIS) within 4.5 hours, and with door to needle time of <60min may optimize recovery. It is unknown if onset to PSC time goals is a predictor of outcome. The purpose of this study was to examine effects of symptom onset to PSC time goals on recovery.
Methods: A retrospective analysis of prospectively collected UCSD SPOTRIAS data was performed. IV rtPA AIS patients were included if they were treated within 270 minutes, and had known 90 day mRS. In-hospital strokes were excluded. Primary outcome was good 90 day mRS(0-2) as predicted by: onset to needle, onset to imaging, onset to stroke code, onset to neuro exam, onset to labs, and onset to decision. Logistic regression was performed (categorized by quartiles).
Results: 291 patients were included (49.8% female, mean age 70.6, median NIHSS 10). Group differences included: HTN (p=0.0002), A.fib (p=0.0005), pre-stroke mRS (p<0.0001), and ethnicity (p =0.0112). Good outcome occurred in 45.0%. Comparing good to poor outcome groups: Mean onset to arrival was 70.6min vs. 62.5min (p=0.13). Mean onset to needle was 140.1min vs. 134.9min (p=0.18). There were no differences in other onset to time goals. Controlling for pre-specified covariates and multiple comparisons, onset to arrival (F-test p=0.09), onset to needle time (F-test unadj p=0.06), onset to stroke code (F-test unadj p=0.20), onset to neuro exam (F-test unadj p=0.28), onset to imaging (F-test unadj p=0.11), onset to lab (F-test unadj p=0.86), and onset to decision (F-test p=0.045) were not significant predictors of 90 day outcome.
Conclusions: In an academic center providing comprehensive stroke services, onset to time goals was not a significant predictor of 90 day outcome. Expedited care processes in comprehensive stroke centers may compensate for differences in outcomes based on onset time. These results should be validated in a larger cohort in PSCs vs. CSCs.
- © 2012 by American Heart Association, Inc.