Introduction and Hypothesis: Since the introduction of thrombolysis with recombinant rtPA for the treatment of acute ischemic stroke it has been well-established that there exists a relatively narrow window for therapeutic intervention. Therefore, a substantial number of investigations sought to identify factors that delay patient presentation. However, little is known regarding the impact of time to presentation (TTP) on final outcome particularly when considering patient presenting outside the established time window for acute stroke therapy. We sought to determine whether the TTP is independently associated with the 90-day outcome.
Methods: Retrospective analysis of 270 consecutive acute ischemic stroke patients prospectively evaluated between January 2013 and February 2014. Multivariable logistic regression with backward elimination was used to determine whether greater TTP independently predicted a poor 90-day outcome as defined as a modified Rankin scale (mRS) score of 3-6 after adjustment for known predictors of stroke outcome.
Results: TTP (per hour; P=0.014; OR 1.013; 95%-CI 1.003-1.023), age (per year; P=0.005; OR 1.044; 95%-CI 1.013-1.076), NIHSS (per point; P<0.001; OR 1.247; 95%-CI 1.168-1.331), and preadmission mRS (per step; P=0.001; OR 1.969; 95%-CI 1.316-2.948) independently predicted a poor 90-day outcome These results did not meaningfully change when patients eligible for rtPA or neurointervention were excluded.
Conclusion: Each hour delay of presentation to neurological evaluation decreased the chance for a good outcome by 1.3% independent of other established outcome predictors. Continued efforts to counsel the public to seek immediate medical attention as well as to expedite patient evaluation by neurologists after ischemic stroke, even when ineligible for acute intervention, are critical to reduce the risk for a poor outcome.