Background: Rapid assessment of patients that present to the emergency center with acute stroke symptoms is crucial to the timely administration of intravenous thrombolysis. The “golden hour” is recognized by the American Heart Association as the standard of care for treatment of acute ischemic stroke . Door to treatment in ≤ 60 minutes can be difficult to achieve, and in 2010 < 30% of hospitals participating in GWTG attained this goal . One step that can be particularly challenging during the expedited stroke assessment is door to head CT interpretation time in ≤ 45 minutes. We sought to determine factors that delay head CT turnaround times > 45 minutes.
Methods: A retrospective stroke database review was completed on 165 patients presenting to the emergency center with acute stroke symptoms in the 0-4.5 hour time window from January 2014 to May 2015. Inclusion criteria was age 18-95 years with an initial NIHSS of 1-42, and a head CT completed at our hospital. Inpatients that developed acute stroke symptoms were excluded from the study. Patients were further stratified by NIHSS and age.
Results: The mean age was 75 years and 50% were female. The average head CT turnaround time was 38.1 minutes and the average NIHSS was 8.11. Fifty three patients (32.1%) received acute reperfusion therapy. The average head CT turnaround time for a NIHSS of 1-3 was 47.4 minutes; NIHSS of 4-9 was 38.4 minutes; NIHSS of 10-24 was 25.2 minutes; NIHSS ≥ 25 was 34.5 minutes. There was no significant difference in the head CT turnaround time based on age.
Conclusion: Patients presenting to the emergency center with a NIHSS of 1-3 had delayed head CT turnaround times compared to patients presenting with more severe stroke symptoms, and furthermore, did not meet the goal head CT interpretation time of ≤ 45 minutes. One possible reason for this finding is that patients with minor stroke symptoms are less likely to receive intravenous thrombolysis. However, expanding literature suggests that nearly 30% of patients with lower NIHSS scores at discharge have significant disability at 90 days . Multiple educational interventions will be implemented in the emergency center to improve head CT turnaround times in patients with low NIHSS scores on presentation.