Pre-hospital notification is associated with improved stroke thrombolysis timing

Area of Science:

• Neurology
• Emergency Medicine
• Radiology

Background:

• Intravenous thrombolysis is a time-sensitive treatment for acute ischemic stroke.
• Optimizing treatment timing is crucial for improving patient outcomes and disability-free survival.

Purpose of the Study:

• To evaluate the impact of pre-hospital notification, on-site CT scanner availability, and out-of-hours thrombolysis services on thrombolysis timing.
• To identify factors influencing delays in stroke treatment.

Main Methods:

• A retrospective analysis of 182 acute ischemic stroke patients treated with thrombolysis between May 2012 and June 2014.
• Data collected included time to stroke physician assessment, cranial CT imaging, and door-to-needle time.
• Logistic regression was used to identify predictors of timely treatment.

Main Results:

• Pre-hospital notification was associated with significantly faster CT scanning (60% vs 24%), earlier physician assessment (median 6 vs 32 minutes), and higher rates of thrombolysis within 60 minutes (89% vs 49%).
• On-site CT scanners and pre-hospital notification independently predicted door-to-CT times under 25 minutes.
• Pre-hospital notification and stroke severity predicted door-to-thrombolysis times under 60 minutes.

Conclusions:

• Pre-hospital notification is a key factor in reducing delays for stroke assessment, CT imaging, and thrombolysis.
• On-site CT scanners also contribute to faster diagnostic imaging.
• Out-of-hours thrombolysis services did not introduce additional delays in this study.