Observational Multicenter Study of a Direct-to-CT Protocol for EMS-transported Patients with Suspected Stroke

Area of Science:

• Neurology
• Emergency Medicine
• Radiology

Background:

• Acute ischemic stroke requires rapid intervention to minimize brain damage.
• Door-to-needle time is a critical metric for successful treatment with tissue plasminogen activator (tPA).
• Direct-to-CT protocols aim to streamline the evaluation process for suspected stroke patients arriving via EMS.

Purpose of the Study:

• To evaluate the impact of a direct-to-CT protocol on reducing door-to-CT-ordered and door-to-needle times for EMS-transported stroke patients.
• To assess the time savings associated with bypassing the emergency department (ED) evaluation before CT scanning.
• To test the hypothesis that direct-to-CT protocols decrease critical time intervals in stroke care.

Main Methods:

• An observational, multicenter before-and-after study design was employed.
• Data were collected from seven hospitals on EMS patients with suspected stroke before and after implementing direct-to-CT protocols.
• Time metrics including ED arrival, CT order, and tPA initiation were analyzed using descriptive statistics and the Mann-Whitney test.

Main Results:

• The median door-to-CT-ordered time decreased from 7 to 4 minutes (p < 0.0001), and door-to-CT-started time decreased from 6 to 10 minutes (p < 0.0001).
• The median door-to-needle time for patients receiving tPA remained unchanged at 42 minutes before and 44 minutes after protocol implementation (p = 0.78).
• Only one of seven hospitals demonstrated a significant decrease in door-to-needle time.

Conclusions:

• Direct-to-CT protocols resulted in minimal reductions in door-to-CT times for EMS stroke patients.
• These protocols did not significantly impact overall door-to-needle times, a key indicator for acute ischemic stroke treatment efficacy.
• Further optimization may be needed to achieve substantial time savings in stroke care pathways.