Workflow in Acute Stroke: What Is the 90th Percentile?
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The manner in which information is presented can profoundly affect the interpretation of that information and, consequently, any action taken. As an illustrative example, let us assume that swimming pools across the country have to report the time it takes to rescue a child who is drowning. As a parent, would you be satisfied if the median time to rescue a drowning child was 30 seconds? Knowing that a lifeguard could reach your child in only half a minute may be comforting. However, this comfort likely would not last if you were then informed that the 90th percentile is 6 minutes, a time which is likely life-threatening. We argue here that acute ischemic stroke treatment faces a similar reporting issue and that we should be doing more to acknowledge and improve the 90th percentile for stroke patients.
We recommend that investigators report interval times with the 90th percentile, in addition to median and interquartile range, in their primary results on paper and at presentation. In the long run, this change would allow us to focus on ensuring that the majority of patients are treated within an acceptable time frame, rather than only 50% of patients. Additionally, efforts tailored to improving the 90th percentile would result in improved systems of care and stroke outcomes.
Based on data from recent endovascular trials, it is absolutely clear that when it comes to stroke treatment, time is brain.1–5 The longer the time from onset to reperfusion, the lower the likelihood of good outcome.6 The effect of time delay is even more pronounced when one considers onset to randomization times in endovascular trials.1–5 This is not because of physiological factors; rather, it is the result of these trials overtly selecting patients based on favorable imaging. In all of …