Abstract T P328: Patients with Low NIHSS Stroke Scales Have Longer Door to Needle Times: An Analysis of a Telestroke Network
Background: The benefits of intravenous tissue-type plasminogen activator (IV tPA) in acute ischemic stroke are time dependent. We hypothesized that patients with lower stroke scales would have longer door to needle times (DNT), in addition to other time dependent measures, compared to patients with higher stroke scales because emergency rooms more readily start a stroke alert with more severe symptoms.
Methods: Data obtained from the 17-partner hospital Providence stroke registry was used to identify AIS (Acute Ischemic Stroke) patients who received IV tPA within 4.5 hours of symptom onset. NIHSS stroke scores were abstracted prior to tPA administration at the time of ED presentation and categorized into 0 through 5 and 6 through 42, as minor and non-minor strokes respectively. Mean DNT were collected for both groups as the primary outcome variable. Analysis of variance was performed to assess differences in DNT, door to CT (DCT) and door to physician evaluation (DPE) between the minor and non-minor NIHSS groups.
Results: A total of 131 AIS patients who received IV tPA within 4.5 hours of symptom onset were identified. Among those, 22 patients presented with a NIHSS ≤ 5 (minor) and 109 patients with a NIHSS > 5 (non-minor). Patients with minor strokes had significantly higher mean DNT times (67.9 ±11.7minutes) compared to those with non-minor strokes (61.2± 13.6 minutes), (p=.036). Mean DCT times were not significantly different between minor ( 17.3 ± 9.5 minutes) and non-minor ( 15.2± 8.3 minutes) strokes, (p=.321). Mean DPE was also not significantly different between minor (4.8±4.7 minutes) and non-minor (4.3 ± 5.0 minutes) strokes (p=.791).
Conclusion: In patients receiving IV tPA for ischemic stroke in a telestroke network, having lower NIHSS stroke scale was associated with longer DNT. Further analysis with a larger sample is needed to determine if other factors impact this association.
Author Disclosures: A. Bhatt: None. A. Lesko: None. A. Kansara: None. E. Baraban: None.
- © 2015 by American Heart Association, Inc.