Kori Sauser1, Dawn M Bravata2, Rodney A Hayward3, Deborah A Levine4. 1. Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: ksauser@partners.org. 2. VHA HSR&D Stroke Quality Enhancement Research Initiative Program, Center for Health Information and Communication, Indianapolis, Indiana; Regenstrief Institute, Indianapolis, Indiana; Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana. 3. Department of Medicine, University of Michigan, Ann Arbor, Michigan; Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital, Ann Arbor, Michigan. 4. Department of Medicine, University of Michigan, Ann Arbor, Michigan; Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital, Ann Arbor, Michigan; Department of Neurology, University of Michigan, Ann Arbor, Michigan.
Abstract
BACKGROUND: Rapid brain imaging for ischemic stroke is important for patient outcomes. We sought to determine the proportion of ischemic stroke patients receiving brain imaging within the guideline-recommended 24 hours, and predictors of faster imaging among patients with acute symptoms. METHODS: Retrospective analysis of Veterans Health Administration (VHA) Office of Performance Measurement Stroke Special Project data. Of 3000 ischemic stroke patients, secondary samples included 649 presenting within 6 hours of onset, and 217 potentially tissue plasminogen activator (tPA)-eligible patients (onset-to-arrival time <3 hours, National Institutes of Health Stroke Scale >2). Two linear regression models examined the association between door-to-imaging time and predictors among secondary samples, accounting for clustering within hospital. RESULTS: Of the 3000 ischemic stroke patients, 97.1% had brain imaging within 24 hours. Among patients presenting within 6 hours of onset, median door-to-imaging time was 59 minutes (interquartile range [IQR], 33-109). Predictors of faster door-to-imaging time included elevated arrival blood pressure and stroke center presentation. Among the potentially tPA-eligible patients, median door-to-imaging time was 52 minutes (IQR, 31-105); no significant predictors were identified. CONCLUSIONS: Nearly all ischemic stroke patients at VHA hospitals have door-to-imaging time within 24 hours. There remains room for improvement for timely brain imaging among patients with acute symptom onset.
BACKGROUND: Rapid brain imaging for ischemic stroke is important for patient outcomes. We sought to determine the proportion of ischemic strokepatients receiving brain imaging within the guideline-recommended 24 hours, and predictors of faster imaging among patients with acute symptoms. METHODS: Retrospective analysis of Veterans Health Administration (VHA) Office of Performance Measurement Stroke Special Project data. Of 3000 ischemic strokepatients, secondary samples included 649 presenting within 6 hours of onset, and 217 potentially tissue plasminogen activator (tPA)-eligible patients (onset-to-arrival time <3 hours, National Institutes of Health Stroke Scale >2). Two linear regression models examined the association between door-to-imaging time and predictors among secondary samples, accounting for clustering within hospital. RESULTS: Of the 3000 ischemic strokepatients, 97.1% had brain imaging within 24 hours. Among patients presenting within 6 hours of onset, median door-to-imaging time was 59 minutes (interquartile range [IQR], 33-109). Predictors of faster door-to-imaging time included elevated arrival blood pressure and stroke center presentation. Among the potentially tPA-eligible patients, median door-to-imaging time was 52 minutes (IQR, 31-105); no significant predictors were identified. CONCLUSIONS: Nearly all ischemic strokepatients at VHA hospitals have door-to-imaging time within 24 hours. There remains room for improvement for timely brain imaging among patients with acute symptom onset.
Authors: Todd A Jaffe; Joshua N Goldstein; Brian J Yun; Mark Etherton; Thabele Leslie-Mazwi; Lee H Schwamm; Kori S Zachrison Journal: West J Emerg Med Date: 2020-07-08
Authors: Alfred Anselme Dabilgou; Alassane Dravé; Julie Marie Adeline Kyelem; Saïdou Ouedraogo; Christian Napon; Jean Kaboré Journal: Stroke Res Treat Date: 2020-06-11
Authors: Kori S Zachrison; Latha Ganti; Dhruv Sharma; Pawan Goyal; Marquita Decker-Palmer; Opeolu Adeoye; Joshua N Goldstein; Edward C Jauch; Bruce M Lo; Tracy E Madsen; William Meurer; John A Oostema; Cindy Mendez-Hernandez; Arjun K Venkatesh Journal: J Am Coll Emerg Physicians Open Date: 2022-07-22