Older Stroke Patients with High Stroke Scores Have Delayed Door-To-Needle Times

Area of Science:

• Neurology
• Emergency Medicine
• Health Services Research

Background:

• Timely administration of intravenous tissue plasminogen activator (IV t-PA) is critical for acute ischemic stroke patients.
• Door-to-needle (DTN) time is a key quality improvement metric in stroke care.

Purpose of the Study:

• To identify factors associated with delayed DTN times in acute ischemic stroke patients treated within a telestroke network.
• To investigate the relationship between patient demographics, stroke severity, and treatment delays.

Main Methods:

• Retrospective review of a 5-hospital telestroke network database (January 2010 - January 2015).
• Inclusion of all acute ischemic stroke patients receiving IV t-PA.
• Logistic regression analysis to identify variables associated with DTN time (optimal < 60 minutes).

Main Results:

• 652 patients were analyzed; mean age 70 years.
• Significant factors for DTN time included arrival mode, initial NIHSS score, and age-NIHSS interaction.
• Delays (DTN ≥ 60 minutes) were most frequent in patients >80 years with NIHSS > 10.

Conclusions:

• Older patients with higher NIHSS scores are at higher risk for DTN time delays.
• Delays in this subgroup were not linked to blood pressure or arrival mode.
• Further research is needed to understand and reduce DTN delays in this specific patient population.