A systemized stroke code significantly reduced time intervals for using intravenous tissue plasminogen activator...

Area of Science:

• Neurology
• Emergency Medicine
• Radiology

Background:

• Stroke codes expedite treatment for acute ischemic stroke (AIS).
• Magnetic resonance imaging (MRI)-based thrombolysis shows promise for improved AIS outcomes compared to computed tomography (CT).
• Rapid assessment and treatment are crucial for AIS patients.

Purpose of the Study:

• To evaluate the impact of a computerized stroke code (CODE RED) on treatment times and outcomes in AIS patients.
• To assess the effectiveness of MRI-based thrombolysis within a structured stroke code system.

Main Methods:

• Implementation of CODE RED, a computerized stroke code, in January 2009.
• Retrospective analysis of AIS patients receiving intravenous tissue plasminogen activator (IV t-PA) from January 2007 to May 2013.
• Comparison of treatment intervals and 90-day modified Rankin Scale (mRS) scores between pre- and post-CODE RED periods, stratified by imaging modality (MRI vs. CT).

Main Results:

• CODE RED implementation significantly reduced door-to-image, door-to-needle, and onset-to-needle times by 11, 18, and 22 minutes, respectively, for MRI-based thrombolysis.
• The proportion of favorable outcomes (mRS 0-2) increased significantly from 41.5% to 60.1% in the post-CODE RED period for MRI-based thrombolysis (P = .02).
• Ordinal regression indicated a trend towards favorable outcomes with the stroke code, even after adjusting for covariates (OR, .99-2.87; P = .059).

Conclusions:

• A systemized stroke code, like CODE RED, effectively shortens IV t-PA treatment intervals for AIS patients undergoing MRI screening.
• The findings suggest that a structured stroke code system may enhance the efficacy of MRI-based thrombolysis in improving patient outcomes.
• Further prospective studies are warranted to confirm the benefits of systemized stroke codes in MRI-guided thrombolysis for AIS.