Workflow and Short-Term Functional Outcomes in Simultaneous Acute Code Stroke Activation and Stroke Reperfusion...

Area of Science:

• Emergency Medicine
• Neurology
• Healthcare Management

Background:

• Simultaneous acute code stroke activation (ACSA) presents a growing challenge in emergency departments.
• The impact of simultaneous ACSA on patient workflow and outcomes is not well understood.
• Optimizing emergency care for acute stroke patients requires evaluating complex activation scenarios.

Purpose of the Study:

• To assess the effect of simultaneous ACSA on workflow metrics, specifically door-to-CT (DTC) time.
• To evaluate the impact of simultaneous ACSA on functional outcome, measured as home time at 90 days.
• To determine the frequency of simultaneous ACSA in patients receiving acute reperfusion therapies.

Main Methods:

• Retrospective analysis of 2605 acute code stroke activations.
• Defined simultaneous ACSA based on timing relative to reperfusion therapies (thrombolysis, thrombectomy) or no reperfusion.
• Assessed workflow using door-to-CT (DTC) time and functional outcome using 90-day home time.

Main Results:

• 33% of ACSA events were simultaneous, with 40.4% of patients receiving reperfusion therapy undergoing simultaneous treatments.
• Grade 3 simultaneous ACSA was associated with significantly prolonged median DTC times (18 vs. 15 minutes).
• No significant difference in median 90-day home time was observed between simultaneous and non-simultaneous ACSA patients.

Conclusions:

• Simultaneous ACSA is a frequent occurrence in patients undergoing acute reperfusion therapies.
• While simultaneous ACSA can delay diagnostic imaging (DTC), it does not appear to negatively affect long-term functional outcomes (90-day home time).
• Implementing optimal workflows in high-volume stroke centers may mitigate the clinical and system burdens associated with simultaneous ACSA.