Stroke Severity Affects Timing: Time From Stroke Code Activation to Initial Imaging is Longer in Patients With Milder...

Area of Science:

• Neurology
• Emergency Medicine
• Health Services Research

Background:

• Rapid stroke imaging is critical for effective treatment.
• Door-to-imaging time is a key metric, but influenced by pre-recognition delays.
• Code-to-imaging time (CIT) isolates response bias after stroke code activation.

Purpose of the Study:

• To investigate the association between stroke severity and code-to-imaging time (CIT).
• To determine if stroke code responders' perception of severity influences patient assessment speed.
• To identify potential biases in stroke response based on National Institutes of Health Stroke Scale (NIHSS) scores.

Main Methods:

• Retrospective analysis of ischemic stroke patients at The Mount Sinai Hospital.
• Calculation of code-to-imaging time (CIT) from stroke code activation to initial imaging.
• Statistical analysis including spline regression, t tests, and multivariable linear regression using NIHSS scores, adjusting for demographics.

Main Results:

• Mean CIT was 26 minutes; mean NIHSS was 8.
• Univariate and multivariate analyses revealed that NIHSS scores < 4 were associated with significantly longer CIT.
• A threshold effect was observed at NIHSS of 4, indicating milder strokes had longer response times.

Conclusions:

• Stroke severity, particularly milder presentations (NIHSS < 4), is associated with longer code-to-imaging times.
• Responder bias may lead to delays in imaging for less severe strokes.
• Further research is needed to address these response time disparities in stroke care.