RT Journal Article
SR Electronic
T1 A Door-to-Needle Time Under 30 Minutes Can Be Achieved and Can Improve Functional Outcomes (S21.004)
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP S21.004
VO 84
IS 14 Supplement
A1 Whaley, Michelle
A1 Caputo, Lisa
A1 Kozlowski, Mark
A1 Fanale, Christopher
A1 Wagner, Jeffrey
A1 Bar-Or, David
YR 2015
UL http://n.neurology.org/content/84/14_Supplement/S21.004.abstract
AB OBJECTIVE: Our study objectives were to describe interventions administered by our Comprehensive Stroke Center to improve door-to-needle (DTN) time, report median DTN times, and determine if interventions influenced functional outcomes and symptomatic intracerebral hemorrhage (sICH) rates. BACKGROUND:Improvements in functional outcomes are greatest when intravenous tissue plasminogen activator (IV-tPA) is administered immediately following acute ischemic stroke (AIS). DESIGN/METHODS:A DTN task force was created to streamline care of suspected AIS patients; interventions included developing a launch pad for emergent evaluation near registration staffed by a neurologist, physician and stroke program coordinator, transferring patients directly to computed tomography (CT) room before entering an emergency department (ED) room, and giving IV-tPA in the CT room. We examined patients that received IV-tPA between 1/1/10-6/25/14 and compared median DTN times and discharge modified Rankin Scale (mRS) values over the study period using the Kruskal-Wallis analysis of variance. The chi-square trend test was used to compare proportions of patients receiving IV-tPA in less than 60 minutes. RESULTS:During the study period, 245 patients received IV-tPA. There was a significant decrease in median DTN times over time, from 46 minutes in 2010 to 29 minutes in 2014 (p=.001). There was also a significant trend demonstrating an increase in the proportion of patients treated under 30 minutes and decreases in the proportions of patients treated in 31-60 minutes and over 60 minutes (p<.001). This trend included an increase from 4.7[percnt] to 51.4[percnt] of patients treated within 30 minutes in 2010 v 2014. Additionally, discharge mRS significantly improved over time (p=.03). There was 1 case of sICH in 2010 and 2012. CONCLUSIONS:Streamlining the initial evaluation process for suspected AIS patients can reduce DTN times, and was also associated with improvements in functional outcomes at discharge. There was no change in sICH rates.Disclosure: Dr. Whaley has nothing to disclose. Dr. Caputo has nothing to disclose. Dr. Kozlowski has nothing to disclose. Dr. Fanale has received personal compensation for activities with Genentech, Inc. as a speaker. Dr. Wagner has received personal compensation for activities with Genentech, Inc. Dr. Bar-Or has nothing to disclose.Wednesday, April 22 2015, 2:00 pm-3:45 pm